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Impact of a multiplex PCR assay (FilmArray®) on the management of patients with suspected central nervous system infections

  • Marine Cailleaux
  • Benoît PilmisEmail author
  • Assaf Mizrahi
  • Julie Lourtet-Hascoet
  • Jean-Claude Nguyen Van
  • Lilian Alix
  • Carine Couzigou
  • Barbara Vidal
  • Pierre Tattevin
  • Alban Le Monnier
Original Article
  • 82 Downloads

Abstract

Microbiological diagnosis of central nervous system (CNS) infections is challenging due to limited access to CNS samples, overlap between meningitis and encephalitis, and the multiplicity of pathogens potentially involved. We aimed to estimate the impact of a commercial multiplex PCR assay (FilmArray® meningitis/encephalitis) on the management of patients with suspicion of meningitis or encephalitis, in terms of time to diagnosis, antimicrobial agents use, duration of hospitalization, and costs. This prospective observational study was conducted at Saint Joseph Hospital (Paris, France) from December 2016 to December 2017. All CSF samples sent to the microbiology laboratory for suspicion of meningitis and/or encephalitis, with CSF cells count > 5 cells/μL, were tested by meningitis/encephalitis multiplex PCR assay. One hundred thirty patients were included. The multiplex PCR assay was positive in 33 patients (25%). Main pathogens found were Enterovirus (n = 12), Varicella-Zoster virus (n = 7), Herpes simplex virus-2 (n = 6), and Listeria monocytogenes (n = 3) as main pathogens. The multiplex PCR assay reduced time to microbiological diagnosis by 3.3 ± 1.6 days and allowed an earlier discontinuation of empirical anti-infective drugs in 42 patients (32%) and an earlier hospital discharge in 23 patients (18%), with an estimated saving of 82 hospital days overall, and a management cost reduction of 26,242 € (201 €/patient). The systematic use of the FilmArray® meningitis/encephalitis multiplex PCR assay may allow earlier diagnosis, earlier discontinuation of empirical treatment, reduced duration of stay, and costs reduction.

Keywords

Meningitis Encephalitis Multiplex PCR 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Saint Joseph Hospital institutional ethical board.

Statement of informed consent

No informed consent was needed for this study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Marine Cailleaux
    • 1
    • 2
  • Benoît Pilmis
    • 2
    • 3
    Email author
  • Assaf Mizrahi
    • 3
    • 4
  • Julie Lourtet-Hascoet
    • 4
  • Jean-Claude Nguyen Van
    • 4
  • Lilian Alix
    • 5
  • Carine Couzigou
    • 2
  • Barbara Vidal
    • 2
  • Pierre Tattevin
    • 1
  • Alban Le Monnier
    • 3
  1. 1.Service de Maladies InfectieusesCHU de RennesRennesFrance
  2. 2.Equipe Mobile de Microbiologie CliniqueGroupe Hospitalier Paris Saint-JosephParisFrance
  3. 3.EA4043 Unité Bactéries Pathogènes et Santé (UBaPS)Université Paris-Sud Paris SaclayParisFrance
  4. 4.Laboratoire de Microbiologie CliniqueGroupe Hospitalier Paris Saint-JosephParisFrance
  5. 5.Service de Médecine Interne et Immunologie CliniqueCHU de RennesRennesFrance

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