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

• Published in: PloS one Vol. 14; no. 10; p. e0223887
• Main Authors: Boudet, Agathe, Pantel, Alix, Carles, Marie-Josée, Boclé, Hélène, Charachon, Sylvie, Enault, Cécilia, Stéphan, Robin, Cadot, Lucile, Lavigne, Jean-Philippe, Marchandin, Hélène
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.10.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Antigens; Automation; Bacteria; Bacteria - classification; Bacteria - isolation & purification; Bacterial diseases; Bacterial infections; Biology and Life Sciences; Care and treatment; Cell culture; Cerebrospinal fluid; Child; Child, Preschool; Contamination; Diagnosis; Encephalitis; Encephalitis - diagnosis; Encephalitis - etiology; Enteroviruses; Extreme values; Female; Fungi - classification; Fungi - isolation & purification; Gram stain; Hemophilus infections; Herpes viruses; Hospitals, University; Human health and pathology; Humans; Infant; Infant, Newborn; Infectious diseases; Laboratories; Life Sciences; Male; Medical diagnosis; Medical equipment; Medicine and Health Sciences; Meningitis; Meningitis - diagnosis; Meningitis - etiology; Meningoencephalitis; Microbiology; Middle Aged; Molecular Diagnostic Techniques - methods; Morbidity; Mortality; Neonatology; Neurobiology; Neurons and Cognition; Pathogenic microorganisms; Pathogens; Patients; Pediatrics; People and Places; Physical Sciences; Pleocytosis; Polymerase chain reaction; Prognosis; Retrospective Studies; Santé publique et épidémiologie; Stains; Streptococcus infections; Time Factors; Viruses - classification; Viruses - isolation & purification; Visualization (Computer); Young Adult; France
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0223887

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.