Editor’s Note: Despite ongoing developments in antimicrobial drugs and vaccines, the diagnosis of bacterial meningitis and viral encephalitis remains challenging due to their varied clinical presentations and is closely associated with high mortality rates. Traditional diagnostic methods have limitations, such as low positivity rates and lengthy processing times for cerebrospinal fluid (CSF) cultures, making early clinical diagnosis and treatment particularly difficult, especially in pediatric patients. At the 34th European Congress of Clinical Microbiology and Infectious Diseases (ESCMID Global 2024), a study by Professor Qing Cao’s team from Shanghai Children’s Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, Professor Gang Liu’s team from Beijing Children’s Hospital affiliated with Capital Medical University, and Professor Haiyin Wang’s team from Shanghai Municipal Health and Health Development Center was selected for an e-poster presentation. This study assessed the impact of the FilmArray Meningitis/Encephalitis Panel (FA-ME) on clinical outcomes and healthcare economics for pediatric patients.
Bacterial meningitis and viral encephalitis are infectious diseases of the central nervous system that are common in children and can present with symptoms such as coma, high fever, seizures, vomiting, and convulsions. If not diagnosed and treated effectively, these diseases can invade the brain substance, cerebral arteries, cranial nerves, and spinal cord, leading to symptoms of meningeal irritation, increased intracranial pressure, and damage to brain tissue, resulting in high disability and mortality rates.
Currently, the diagnosis of meningitis and encephalitis relies on a series of laboratory tests including routine CSF analysis, biochemical tests, CSF culture, smears, and peripheral blood white blood cell counts. However, in the early stages of infection, changes in routine CSF and biochemical tests in children are not typical, and CSF cultures are time-consuming, have low positivity rates, and may be contaminated, along with contraindications or non-cooperation for lumbar puncture, which creates a demand for more rapid and accurate diagnostic methods.
This is a multi-center, prospective, randomized controlled study assessing the impact of syndrome-based PCR testing on the clinical outcomes and healthcare economics of Chinese children with meningitis/encephalitis (Abstract No.: ALP0402).
Background
The FilmArray Meningitis/Encephalitis Panel (FA-ME) is a syndrome-based multiplex PCR test that can detect 14 common pathogens causing meningitis and encephalitis within one hour. The purpose of this study is to evaluate the impact of using FA-ME on clinical outcomes and healthcare economics in pediatric patients.
Methods
This study is a prospective, randomized controlled trial conducted at two children’s hospitals in China. Suspected pediatric patients (under 18 years old) with meningitis/encephalitis were randomized 1:1 into either the FA-ME group or the standard of care (SOC) group. Both groups underwent routine laboratory pathogen testing. In the FA-ME group, patients’ CSF was also tested using FA-ME. All patients were treated according to clinical guidelines and routine practices.
Results
Pathogen detection
From October 2020 to December 2022, a total of 183 children were randomized into the FA-ME group (90) and the SOC group (93).
- The bacterial detection rates in the FA-ME group and the SOC group were 13.33% (12/90) and 9.67% (9/93), respectively.
- FA-ME additionally detected 7 types of viruses.
Clinical and Health Economics Benefits
- The duration of antimicrobial therapy, hospitalization time, and total hospital costs all trended downwards in the FA-ME group, although no statistical differences were observed.
- Subgroup analyses further revealed significant reductions in the FA-ME group compared to the SOC group in terms of the duration of antimicrobial therapy for critically ill patients (18.50±10.10 days vs. 29.06±9.77 days, P=0.004) and hospitalization time (19.56±9.41 days vs. 29.56±10.63 days, P=0.007).
- In patients under one year of age, the total hospital costs were also significantly reduced in the FA-ME group (27977±16227 vs. 41006±29842, P=0.025).
Conclusion
The FilmArray Meningitis/Encephalitis Panel (FA-ME) demonstrates higher detection rates for bacteria and viruses causing meningitis and encephalitis than standard laboratory testing methods. The use of FA-ME can bring potential clinical benefits and economic value in healthcare, particularly for suspected pediatric patients with meningitis and encephalitis, especially in critically ill and infants under one year old.
References
Zhenzhen Dou, Yue Tao, XiaoXiao Qin, et al. A multicentre, prospective, randomised controlled study to evaluate the impact of syndromic PCR testing on clinical efficacy and health economics in paediatric meningitis/encephalitis patients in China. ESCMID Global 2024; ePoster ALP0402.
Professor Qing Cao
- Medical Doctor
- Chief Physician, Master’s Supervisor
Positions:
- Director of General Internal Medicine and Infectious Diseases, Shanghai Children’s Medical Center, affiliated with Shanghai Jiao Tong University School of Medicine
- Head of the Pediatric Teaching and Research Office, Director of Pediatric Standardized Training Base
- Director of Infection and Immunity Center, Vice-Director of Infectious Research Lab at the Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center
Additional Roles:
- Vice Chair of the Shanghai Medical Association of Infections and Chemotherapy
- Vice Leader of the Pediatric Group, Infection Section, Shanghai Medical Association
- Secretary of the Pediatric Committee, Shanghai Medical Association
- Member of the Pediatric Infectious Diseases Committee, Chinese Medical Association
- Member of the Expert Committee on Rational Use and Management of Antimicrobials, Shanghai
Reviewer: Serves as a peer reviewer for journals such as “Chinese Journal of Pediatrics” and “Pediatrics & Neonatology.”
Research Interests: Pathogen and host immune mechanisms, sepsis pathogenesis, pharmacogenomics and drug level monitoring in sepsis treatment, bacteriocin mechanisms in sepsis related to intestinal endogenous infection and bacterial translocation, clinical application of fecal microbiota transplantation in children, and vaccination evaluation in special populations.
