Retrospective Evaluation of Infants Aged 1 to 60 Days with Residual Cerebrospinal Fluid (CSF) Tested Using the FilmArray Meningitis/Encephalitis (ME) Panel.

Anne J Blaschke,Ernest K Korgenski,Jennifer Dien Bard,Kristen J Kanack,Kristen M Holmberg,Kevin M Bourzac,Amy L Leber,Judy A Daly,Geoffrey A Land

doi:10.1128/jcm.00277-18

Abstract

ABSTRACTIn pediatric practice it is common for infants under 2 months of age to undergo evaluation for sepsis when they are ill, often including lumbar puncture to assess for central nervous system (CNS) infection. The FilmArray Meningitis/Encephalitis (ME) panel is a newly approved test for rapid identification of CNS pathogens. Our objective was to study the epidemiology of CNS infection in young infants and the potential impact of rapid multiplex PCR on their care. A performance evaluation of the FilmArray ME panel was conducted from February 2014 to September 2014 at 11 sites. FilmArray ME panel results were compared to reference standards but not shared with providers. In our study, medical records for infants (aged 1 to 60 days) enrolled at three sites were reviewed for clinical, laboratory, and outcome data. A total of 145 infants were reviewed. The median age was 25 days. Most of the infants were hospitalized (134/145 [92%]) and received antibiotics (123/145 [85%]), and almost half (71/145 [49%]) received acyclovir. One infant had a bacterial pathogen, likely false positive, identified by the FilmArray ME panel. Thirty-six infants (25%) had a viral pathogen detected, including 21 enteroviruses. All infants with enteroviral meningitis detected by the FilmArray ME panel and conventional PCR were hospitalized, but 20% were discharged in less than 24 h when conventional PCR results became available. The FilmArray ME panel may play a role in the evaluation of young infants for CNS infection. Results may be used to guide management, possibly resulting in a decreased length of stay and less antimicrobial exposure for infants with low-risk viral infection detected.

Highlights

In pediatric practice it is common for infants under 2 months of age to undergo evaluation for sepsis when they are ill, often including lumbar puncture to assess for central nervous system (CNS) infection
A total of 37 infants (26%) had pathogens identified by the FilmArray ME panel, and 21 (14%) had pathogens identified by conventional methods
While our study supports a risk of false-positive results with highly sensitive molecular testing [14], a rapid molecular diagnostic such as the FilmArray ME panel could aid in quickly identifying those infants with both serious CNS illness and those at reduced risk

Summary

Introduction

In pediatric practice it is common for infants under 2 months of age to undergo evaluation for sepsis when they are ill, often including lumbar puncture to assess for central nervous system (CNS) infection. Infants in the first 2 months of life are at high risk for invasive bacterial infection, and it is the standard of care for them to undergo an evaluation for sepsis when they have fever or other concerning signs, such as lethargy or poor feeding [1]. As part of this evaluation, many infants have a lumbar puncture (LP) performed to assess the possibility of central nervous system (CNS) infection. A recent study in children, including a specific subset of infants with cerebrospinal fluid (CSF) tested for EV or HSV, suggested the potential for clinical impact of a rapid multiplex panel, including more-rapid diagnosis of CNS infection and optimization of antimicrobial therapy [11]

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