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Cited by 49Infectious Encephalopathies and EncephalitisBacterial Infections and VaccinesBacterial Identification and Susceptibility Testing

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

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Boudet, Agathe, Pantel, Alix, Carles, Marie-Josée, Boclé, Hélène, Charachon, Sylvie, Enault, Cécilia, Stéphan, Robin, Cadot, Lucile +2 more·2019·PLOS ONE
DOI 10.1371/journal.pone.0223887PMC PMC6812749
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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.

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  • Previous studies have reported occasional false-positive FilmArray results for GBS.

    “Previous studies have reported occasional false-positive FilmArray results for GBS, including one of the reports cited in our study.”

    From Pathogen detection in acellular cerebrospinal fluid: diagnostic insights from a pediatric cohort in Colombia (2026) · cites this paper as [6]

    The Discussion (page not provided) says previous studies reported false-positive FilmArray results, but it does not identify GBS among them. It mentions S. agalactiae (GBS) only in connection with previously documented false-negative results; the study’s four non-clinically relevant positive results involved H. influenzae and HHV-6. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Previous studies have demonstrated the accuracy and clinical utility of FA-M/E in adults from North America and some European countries.

    “Previous studies have demonstrated the accuracy and clinical utility of FA-M/E in adults from North America and some European countries (5–8).”

    From Epidemiology of pediatric meningitis and encephalitis in Japan: a cross-sectional study (2024) · cites this paper as [6]

    The Introduction reports a prior evaluation that found FA-M/E sensitive and specific, and the Discussion describes faster diagnosis and additional diagnostic yield. This paper’s own study was conducted in France and included both adults and children; the cited passages do not establish that previous studies demonstrated both accuracy and clinical utility specifically in adults across North America and European countries. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The FA-M/E panel can detect bacterial pathogens in cases in which antimicrobial agents were administered prior to blood and CSF culture.

    “The FA-M/E panel can detect bacterial pathogens in cases in which antimicrobial agents were administered prior to blood and CSF culture (6, 13, 30, 31).”

    From Epidemiology of pediatric meningitis and encephalitis in Japan: a cross-sectional study (2024) · cites this paper as [6]

    The Results (Concordance of positive FA-M/E results; page not available) report bacterial detections despite negative CSF cultures, including two patients whose CSF was sampled after treatment began. Table 2 records antibiotics before lumbar puncture for those two patients, but does not establish that antibiotics preceded blood culture in either case. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • This study confirmed that CSF biomarkers have a low negative predictive value for meningitis and encephalitis in children.

    “Third, this study confirmed that CSF biomarkers have a low negative predictive value for meningitis and encephalitis in children (6, 11, 33).”

    From Epidemiology of pediatric meningitis and encephalitis in Japan: a cross-sectional study (2024) · cites this paper as [6]

    The Discussion (page not provided) reports that 8.2% of patients diagnosed with meningitis or encephalitis had acellular CSF and says CSF white-cell count lacks sensitivity in some situations, including pediatric cases discussed there. However, the study did not establish a negative predictive value for CSF biomarkers collectively in children; its own cohort was predominantly adults (Results, Population and sample description; page not provided). (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Another study reported the absence of pleocytosis in only 11% of their positive cases.

    “Similarly, another study reported the absence of pleocytosis in only 11% of their positive cases (6), a figure that stands in sharp opposition to the 100% observed in our cohort.”

    From Pathogen detection in acellular cerebrospinal fluid: diagnostic insights from a pediatric cohort in Colombia (2026) · cites this paper as [6]

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Research works printed but not linked: 33

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Authors
Boudet, A., Pantel, A., Carles, M.-J., Boclé, H., Charachon, S., Enault, C., Stéphan, R., Cadot, L., Lavigne, J.-P., & Marchandin, H.
Affiliations
  • Inserm (FR)
  • Centre Hospitalier Universitaire de Nîmes (FR)
  • Centre National de la Recherche Scientifique (FR)
Corresponding author
Marchandin, Hélène
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2019-10-24
Volume
14
Issue
10
Pages
e0223887
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0223887
PMC
PMC6812749
OpenAlex
W2981412762
Cited by
49
References
8
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 7 · 2022: 11 · 2021: 9 · 2020: 8 · 2019: 1 · 2018: 2
FWCI
5.56
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
Keywords
FilmArray Meningitis/Encephalitis panel, meningitis, encephalitis, molecular diagnosis, cerebrospinal fluid, viral pathogens, pathogenic bacteria, human herpesvirus 6, enterovirus, Haemophilus influenzae, false positives, contamination, Gram staining, cultural comparison, early diagnosis
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Bacteria, Child, Child, Preschool, Encephalitis, Female, Fungi, Hospitals, University, Humans, Infant, Infant, Newborn, Male, Meningitis, Middle Aged, Prognosis, Retrospective Studies, Time Factors, Viruses, Molecular Diagnostic Techniques, Young Adult

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