A review of a 13-month period of FilmArray Meningitis/Encephalitis panel implementation as a first-line diagnosis tool at a university hospital

PLoS One. 2019 Oct 24;14(10):e0223887. doi: 10.1371/journal.pone.0223887. eCollection 2019.

Abstract

Early diagnosis and treatment of meningitis and encephalitis is essential for reducing both their morbidity and mortality. The FilmArray® Meningitis/Encephalitis (FA-M/E) panel is a recently available molecular tool allowing the simultaneous detection of 14 pathogens in about one hour. We evaluated its routine use over a 13-month period at Nîmes University Hospital, France. Cerebrospinal fluid (CSF) specimens were prospectively analyzed, independently of cell count; results were retrospectively analyzed and positive results compared to clinical and microbiological data. Among the 708 patients included (734 CSF samples), 89 (12.6%) had a positive FA-M/E panel, 71 (80%) for a viral pathogen and 18 (20%) for a bacterial pathogen. Enterovirus and HHV-6 were the main detected pathogens. Mean time-to-results was 1h46mn. Four non-clinically relevant results were detected (3 HHV-6 and 1 Haemophilus influenzae) on the basis of inconsistent clinical and/or biological data, and/or after visualization of melting curves. No CSF pleocytosis was observed in 11% of the patients with a positive FA-M/E panel. For the 18 patients with a positive FA-M/E panel for a bacterial pathogen, five (28%) had CSF samples showing a positive Gram stain allowing an early diagnosis of bacterial infection and 67% had CSF displaying a positive culture. Altogether the panel detected 5 cases of bacterial M/E (29%) not diagnosed by culture. Despite undeniable advantages, mainly ease of use, quick result availability, and an extremely low rate of invalid results, measures should be implemented to limit false-positive results due to contamination and a careful interpretation based on the overall data for each patient is required.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteria / classification
  • Bacteria / isolation & purification*
  • Child
  • Child, Preschool
  • Encephalitis / diagnosis*
  • Encephalitis / etiology
  • Female
  • Fungi / classification
  • Fungi / isolation & purification*
  • Hospitals, University
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Meningitis / diagnosis*
  • Meningitis / etiology
  • Middle Aged
  • Molecular Diagnostic Techniques / methods*
  • Prognosis
  • Retrospective Studies
  • Time Factors
  • Viruses / classification
  • Viruses / isolation & purification*
  • Young Adult

Grants and funding

The authors received no specific funding for this work.