Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2020

Open Access 01-12-2020 | Meningoencephalitis | Research article

Comparison of antibiotic and acyclovir usage before and after the implementation of an on-site FilmArray meningitis/encephalitis panel in an academic tertiary pediatric hospital: a retrospective observational study

Authors: Alexandra Hagen, Anna Eichinger, Melanie Meyer-Buehn, Tilmann Schober, Johannes Huebner

Published in: BMC Pediatrics | Issue 1/2020

Login to get access

Abstract

Background

Prompt initiation of empiric therapy is common practice in case of suspected meningitis or encephalitis. However, in children the most common pathogens are viruses that usually do not require and are not covered by the applied anti-infective treatment. Novel multiplex PCR (mPCR) panels provide rapid on-site diagnostic testing for a variety of pathogens. This study compared empiric antibiotic and acyclovir usage before and after the introduction of an on-site FilmArray Meningitis/Encephalitis Panel (FA ME Panel).

Methods

We retrospectively compared data for empiric antibiotic and acyclovir usage between pediatric patients with suspected central nervous system (CNS) infection receiving mPCR testing and a matched historical control group. Patients were matched by age and suspected CNS infection. We included all patients for whom empiric antibiotics and/or acyclovir were prescribed.

Results

Each study group consisted of 46 patients with 29 (63.0%) infants and 17 (37.0%) older children. A viral pathogen was diagnosed in 5/46 (10.9%) patients in the control group (all enteroviruses) and in 14/46 (30.4%) patients in the mPCR group (enterovirus n = 9; human herpesvirus 6 (HHV-6) n = 5), (p = 0.038)). Length of Therapy (LoT) and Days of Therapy (DoT) for antibiotics were significantly lower for infants (4.0 vs. 3.0, p = 0.038 and 8.0 vs. 6.0, p = 0.015, respectively). Acyclovir therapy was significantly shorter for both, infants and older children (3.0 vs. 1.0 day, p < 0.001 for both age groups).

Conclusion

The findings of our study suggest that the introduction of a FA ME Panel into clinical routine procedures is associated with a significantly reduced LoT and DoT of empiric anti-infective treatment in children with suspected meningoencephalitis. The largest effect was observed in infants.
Appendix
Available only for authorised users
Literature
1.
Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the Management of Bacterial Meningitis. Clin Infect Dis. 2004;39:1267–84.PubMedCrossRef
2.
Thompson C, Kneen R, Riordan A, Kelly D, Pollard AJ. Encephalitis in children. Arch Dis Child. 2012;97:150–61.PubMedCrossRef
3.
Raschilas F, Wolff M, Delatour F, Chaffaut C, De Broucker T, Chevret S, et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clin Infect Dis. 2002;35:254–60.PubMedCrossRef
4.
McGrath N, Anderson NE, Croxson MC, Powell KF. Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry. 1997;63:321–6.PubMedPubMedCentralCrossRef
5.
Biondi EA, Byington CL. Evaluation and Management of Febrile, well-appearing young infants. Infect Dis Clin N Am. 2015;29:575–85.CrossRef
6.
Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol. 2015;42:29–45 vii–viii.PubMedCrossRef
7.
Díaz MG, García RP, Gamero DB, González-Tomé MI, Romero PC, Ferrer MM, et al. Lack of accuracy of biomarkers and physical examination to detect bacterial infection in febrile infants. Pediatr Emerg Care. 2016;32:664–8.PubMedCrossRef
8.
9.
10.
Wu J, Mu D. Vascular catheter-related complications in newborns. J Paediatr Child Health. 2012;48:E91–5.PubMedCrossRef
11.
Romano A, Caubet JC. Antibiotic allergies in children and adults: from clinical symptoms to skin testing diagnosis. J Allergy Clin Immunol Pract. 2014;2:3–12.PubMedCrossRef
12.
Silverman MA, Konnikova L, Gerber JS. Impact of antibiotics on necrotizing Enterocolitis and antibiotic-associated diarrhea. Gastroenterol Clin N Am. 2017;46:61–76.CrossRef
13.
Rao S, Abzug MJ, Carosone-Link P, Peterson T, Child J, Siparksy G, et al. Intravenous acyclovir and renal dysfunction in children: a matched case control study. J Pediatr. 2015;166:1462–8 e1–4.PubMedCrossRef
14.
Stiemsma LT, Michels KB. The role of the microbiome in the developmental origins of health and disease. Pediatrics. 2018;141:e20172437.PubMedCrossRef
15.
Messacar K, Breazeale G, Robinson CC, Dominguez SR. Potential clinical impact of the film array meningitis encephalitis panel in children with suspected central nervous system infections. Diagn Microbiol Infect Dis. 2016;86:118–20.PubMedPubMedCentralCrossRef
16.
Blaschke AJ, Holmberg KM, Daly JA, Leber AL, Dien Bard J, Korgenski EK, et al. Retrospective evaluation of infants aged 1 to 60 days with residual cerebrospinal fluid (CSF) tested using the FilmArray meningitis/encephalitis (ME) panel. J Clin Microbiol. 2018;56:e00277–18.PubMedPubMedCentralCrossRef
17.
Hanson KE. The first fully automated molecular diagnostic panel for meningitis and encephalitis: how well does it perform, and when should it be used? J Clin Microbiol. 2016;54:2222–4.PubMedPubMedCentralCrossRef
18.
Soucek DK, Dumkow LE, VanLangen KM, Jameson AP. Cost justification of the BioFire FilmArray meningitis/encephalitis panel versus standard of Care for Diagnosing Meningitis in a community hospital. J Pharm Pract. 2019;32:36–40.PubMedCrossRef
19.
Eichinger A, Hagen A, Meyer-Bühn M, Huebner J. Clinical benefits of introducing real-time multiplex PCR for cerebrospinal fluid as routine diagnostic at a tertiary care pediatric center. Infection. 2019;47:51–8.PubMedCrossRef
20.
King RL, Lorch SA, Cohen DM, Hodinka RL, Cohn KA, Shah SS. Routine cerebrospinal fluid Enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger. Pediatrics. 2007;120:489–96.PubMedCrossRef
21.
Kreitmeyr K, von Both U, Pecar A, Borde JP, Mikolajczyk R, Huebner J. Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards. Infection. 2017;45:493–504.PubMedCrossRef
22.
FilmArray® Meningitis / Encephalitis ( ME ) Panel Instruction Booklet. BioFire A BioMerieux Company. 2015.
23.
Graf EH, Farquharson MV, Cárdenas AM. Comparative evaluation of the FilmArray meningitis/encephalitis molecular panel in a pediatric population. Diagn Microbiol Infect Dis. 2017;87:92–4.PubMedCrossRef
24.
Piccirilli G, Chiereghin A, Gabrielli L, Giannella M, Squarzoni D, Turello G, et al. Infectious meningitis/encephalitis: evaluation of a rapid and fully automated multiplex PCR in the microbiological diagnostic workup. New Microbiol. 2018;41:118–25.PubMed
25.
Leber AL, Everhart K, Balada-Llasat JM, Cullison J, Daly J, Holt S, et al. Multicenter evaluation of BioFire FilmArray meningitis/encephalitis panel for detection of Bacteria, viruses, and yeast in cerebrospinal fluid specimens. J Clin Microbiol. 2016;54:2251–61.PubMedPubMedCentralCrossRef
26.
Van TT, Mongkolrattanothai K, Arevalo M, Lustestica M, Dien BJ. Impact of a rapid herpes simplex virus PCR assay on duration of acyclovir therapy. J Clin Microbiol. 2017;55:1557–65.PubMedPubMedCentralCrossRef
27.
Huizing KMN, Swanink CMA, Landstra AM, van Zwet AA, van Setten PA. Rapid Enterovirus molecular testing in cerebrospinal fluid reduces length of hospitalization and duration of antibiotic therapy in children with aseptic meningitis. Pediatr Infect Dis J. 2011;30:1107–9.PubMedCrossRef
28.
Carrasco Fernández JR, Gómez-Pastrana D, Alados Arboledas JC, Aragón Fernández C, Ortiz TJ. Impact of introducing an enterovirus polymerase chain reaction in the management of aseptic meningitis. An Pediatr (Barc). 2015;82:e26–9.CrossRef
29.
Lyons TW, McAdam AJ, Cohn KA, Monuteaux MC, Nigrovic LE. Impact of in-hospital enteroviral polymerase chain reaction testing on the clinical management of children with meningitis. J Hosp Med. 2012;7:517–20.PubMedCrossRef
30.
Rogers BB, Shankar P, Jerris RC, Kotzbauer D, Anderson EJ, Watson JR, et al. Impact of a rapid respiratory panel test on patient outcomes. Arch Pathol Lab Med. 2015;139:636–41.PubMedCrossRef
31.
Subramony A, Zachariah P, Krones A, Whittier S, Saiman L. Impact of Multiplex Polymerase Chain Reaction Testing for Respiratory Pathogens on Healthcare Resource Utilization for Pediatric Inpatients. J Pediatr. 2016;173:196–201 e2.PubMedPubMedCentralCrossRef
32.
O’Brien MP, Francis JR, Marr IM, Baird RW. Impact of cerebrospinal fluid multiplex assay on diagnosis and outcomes of central nervous system infections in children: a before and after cohort study. Pediatr Infect Dis J. 2018;37:868–71.PubMedCrossRef
33.
34.
Naccache SN, Lustestica M, Fahit M, Mestas J, Dien BJ. One year in the life of a rapid Syndromic panel for meningitis/encephalitis: a pediatric tertiary care Facility’s experience. J Clin Microbiol. 2018;56:e01940–17.PubMedPubMedCentralCrossRef
35.
Okike IO, Johnson AP, Henderson KL, Blackburn RM, Muller-Pebody B, Ladhani SN, et al. Incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United Kingdom and Republic of Ireland: prospective, enhanced, national population-based surveillance. Clin Infect Dis. 2014;59:e150–7.PubMedCrossRef
36.
Curfman AL, Glissmeyer EW, Ahmad FA, Korgenski EK, Blaschke AJ, Byington CL, et al. Initial Presentation of Neonatal Herpes Simplex Virus Infection. J Pediatr. 2016;172:121–6 e1.PubMedCrossRef
37.
Gaensbauer JT, Birkholz M, Pfannenstein K, Todd JK. Herpes PCR testing and empiric acyclovir use beyond the neonatal period. Pediatrics. 2014;134:e651–6.PubMedCrossRef
38.
Puchhammer-Stöckl E, Presterl E, Croÿ C, Aberle S, Popow-Kraupp T, Kundi M, et al. Screening for possible failure of herpes simplex virus PCR in cerebrospinal fluid for the diagnosis of herpes simplex encephalitis. J Med Virol. 2001;64:531–6.PubMedCrossRef
39.
Archimbaud C, Chambon M, Bailly JL, Petit I, Henquell C, Mirand A, et al. Impact of rapid enterovirus molecular diagnosis on the management of infants, children, and adults with aseptic meningitis. J Med Virol. 2009;81:42–8.PubMedCrossRef
40.
Franco-Paredes C, Lammoglia L, Hernández I, Santos-Preciado JI. Epidemiology and outcomes of bacterial meningitis in Mexican children: 10-year experience (1993-2003). Int J Infect Dis. 2008;12:380–6.PubMedCrossRef
41.
Hanson KE, Slechta ES, Killpack JA, Heyrend C, Lunt T, Daly JA, et al. Preclinical assessment of a fully automated multiplex PCR panel for detection of central nervous system pathogens. J Clin Microbiol. 2016;54:785–7.PubMedPubMedCentralCrossRef
42.
Messacar K, Breazeale G, Wei Q, Robinson CC, Dominguez SR. Epidemiology and clinical characteristics of infants with human parechovirus or human herpes virus-6 detected in cerebrospinal fluid tested for enterovirus or herpes simplex virus. J Med Virol. 2015;87:829–35.PubMedCrossRef
43.
Dien Bard J, Alby K. Point-counterpoint: meningitis/encephalitis Syndromic testing in the clinical laboratory. J Clin Microbiol. 2018;56:00018.CrossRef
44.
Walls T, McSweeney A, Anderson T, Jennings LC. Multiplex-PCR for the detection of viruses in the CSF of infants and young children. J Med Virol. 2017;89:559–61.PubMedCrossRef
45.
Ramers C, Billman G, Hartin M, Ho S, Sawyer MH. Impact of a diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management. JAMA. 2000;283:2680–5.PubMedCrossRef
46.
Green DA, Pereira M, Miko B, Radmard S, Whittier S, Thakur K. Clinical significance of human Herpesvirus 6 positivity on the FilmArray meningitis/encephalitis panel. Clin Infect Dis. 2018;67:1125–8.PubMedCrossRef
47.
Robinson CC, Willis M, Meagher A, Gieseker KE, Rotbart H, Glodé MP. Impact of rapid polymerase chain reaction results on management of pediatric patients with enteroviral meningitis. Pediatr Infect Dis J. 2002;21:283–6.PubMedCrossRef
48.
Metadata
Title
Comparison of antibiotic and acyclovir usage before and after the implementation of an on-site FilmArray meningitis/encephalitis panel in an academic tertiary pediatric hospital: a retrospective observational study
Authors
Alexandra Hagen
Anna Eichinger
Melanie Meyer-Buehn
Tilmann Schober
Johannes Huebner
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2020
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-020-1944-2

Other articles of this Issue 1/2020

BMC Pediatrics 1/2020 Go to the issue

Research article

Wheeze and cough measurements at night in children with respiratory symptoms

Research article

Age-period-cohort projection of trends in blood pressure and body mass index in children and adolescents in Hong Kong

Research article

“We can’t handle things we don’t know about”: perceived neurorehabilitation challenges for Malawian paediatric cerebral malaria survivors

Research article

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: a retrospective cohort study

Case report

Hemophagocytic lymphohistiocytosis resulting from a cytokine storm triggered by septicemia in a child with chronic granuloma disease: a case report and literature review

Research article

Comparison of frequency-domain and continuous-wave near-infrared spectroscopy devices during the immediate transition