Clinical and Financial Impact of a Diagnostic Stewardship Program for Children with Suspected Central Nervous System Infection
Open accessAbstract
Objective To investigate the optimal implementation and clinical and financial impacts of the FilmArray Meningitis Encephalitis Panel (MEP) multiplex polymerase chain reaction testing of cerebrospinal fluid (CSF) in children with suspected central nervous system infection. Study design A pre-post quasiexperimental cohort study to investigate the impact of implementing MEP using a rapid CSF diagnostic stewardship program was conducted at Children's Hospital Colorado (CHCO). MEP was implemented with electronic medical record indication selection to guide testing to children meeting approved use criteria: infants <2 months, immunocompromised, encephalitis, and ≥5 white blood cells/μL of CSF. Positive results were communicated with antimicrobial stewardship real-time decision support. All cases with CSF obtained by lumbar puncture sent to the CHCO microbiology laboratory meeting any of the 4 aforementioned criteria were included with preimplementation controls (2015-2016) compared with postimplementation cases (2017-2018). Primary outcome was time-to-optimal antimicrobials compared using log-rank test with Kaplan-Meier analysis. Results Time-to-optimal antimicrobials decreased from 28 hours among 1124 preimplementation controls to 18 hours (P < .0001) among 1127 postimplementation cases (72% with MEP testing conducted). Postimplementation, time-to-positive CSF results was faster (4.8 vs 9.6 hours, P < .0001), intravenous antimicrobial duration was shorter (24 vs 36 hours, P = .004), with infectious neurologic diagnoses more frequently identified (15% vs 10%, P = .03). There were no differences in time-to-effective antimicrobials, hospital admissions, antimicrobial starts, or length of stay. Costs of microbiologic testing increased, but total hospital costs were unchanged. Conclusions Implementation of MEP with a rapid central nervous system diagnostic stewardship program improved antimicrobial use with faster results shortening empiric therapy. Routine MEP testing for high-yield indications enables antimicrobial optimization with unchanged overall costs.
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There are reports of clearly positive impacts of panel assays for meningitis and/or encephalitis diagnostics, including reducing the time to diagnosis and shortening empirical antibiotic use.
“There are reports of clearly positive impacts of the use of panel assays for meningitis and/or encephalitis diagnostics, for instance, in reducing the time to diagnosis and shortening empirical antibiotic use (14, 15).”
From Evaluation of the Novel CE-IVD-Marked Multiplex PCR QIAstat-Dx Meningitis/Encephalitis Panel (2023) · cites this paper as [14]
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- Authors
- Messacar, K., Palmer, C., Gregoire, L., Elliott, A., Ackley, E., Perraillon, M. C., Tyler, K. L., & Dominguez, S. R.
- Affiliations
- Children's Hospital Colorado (US)
- University of Colorado Anschutz (US)
- Colorado School of Public Health (US)
- Corresponding author
- Messacar, Kevin
- ORCID
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2022-05
- Volume
- 244
- Pages
- 161-168.e1
- ISSN
- 0022-3476 (ISSN-L)
- PMC
- PMC9807012
- OpenAlex
- W4211009631
- Cited by
- 34
- References
- 39
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 12 · 2023: 5 · 2022: 4
- FWCI
- 4.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (am, 370 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- The Journal of Pediatrics (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Colorado Clinical and Translational Sciences Institute (UL1 TR002535)
- National Institutes of Health
- NIAID DMID (K23AI28069)
- National Institute of Allergy and Infectious Diseases
- National Center for Advancing Translational Sciences
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Keywords
- FilmArray Meningitis/Encephalitis panel, multiplex PCR, cerebrospinal fluid, central nervous system infection, encephalitis, meningitis, antimicrobial stewardship, diagnostic stewardship, empiric antimicrobial therapy, antimicrobial duration, hospital costs, pediatric infection
- MeSH terms
- Anti-Infective Agents, Anti-Bacterial Agents, Central Nervous System Infections, Child, Encephalitis, Humans, Infant, Meningitis, Nervous System Malformations, Retrospective Studies, Cohort Studies
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