Rev Esp Quimioter 2019; 32(3):246-253

Meningitis/Encephalitis diagnosis in ICU using Multiplex PCR system: Is it time of change?

LUCÍA LÓPEZ-AMOR, DOLORES ESCUDERO, JAVIER FERNÁNDEZ, LORENA MARTÍN-IGLESIAS, LUCÍA VIÑA, JONATHAN FERNÁNDEZ-SUÁREZ, ÁLVARO LEAL-NEGREDO, BLANCA LEOZ, LAURA ÁLVAREZ-GARCÍA, CRISTIAN CASTELLÓ-ABIETAR, JOSÉ ANTONIO BOGA, FERNANDO VÁZQUEZ

Objetive. To evaluate the clinical impact of Meningitis/Encephalitis FilmArray® panel for the diagnosis of cerebral nervous system infection and to compare the results (including time for diagnosis) with those obtained by conventional microbiological techniques.
Patients and methods. A prospective observational study in an Intensive Care Unit of adults from a tertiary hospital was carried out. Cerebrospinal fluid from all patients was taken by lumbar puncture and assessed by the meningitis/encephalitis FilmArray® panel ME, cytochemical study, Gram, and conventional microbiological cultures.
Results. A total of 21 patients admitted with suspicion of Meningitis/Encephalitis. Median age of patients was 58.4 years (RIQ 38.1-67.3), median APACHE II 18 (RIQ 12-24). Median stay in ICU and median hospital stay was 4 (RIQ 2-6) and 17 days (RIQ 14-28), respectively. The overall mortality was 14.3%. A final clinical diagnosis of meningitis or encephalitis was established in 16 patients, obtaining the etiological diagnosis in 12 of them (75%). The most frequent etiology was Streptococcus pneumoniae (8 cases). FilmArray® allowed etiological diagnosis in 3 cases in which the culture had been negative, and the results led to changes in the empirical antimicrobial therapy in 7 of 16 cases (43.8%). FilmArray® yielded a global sensitivity and specificity of 100% and 90%, respectively. The median time to obtain results from the latter and conventional culture (including antibiogram) was 2.9 hours (RIQ 2.1-3.8) and 45.1 hours (RIQ 38.9-58.7), respectively.
Conclusions. The Meningitis/Encephalitis FilmArray® panel was able to establish the etiologic diagnosis faster than conventional methods. Also, it achieved a better sensitivity and led to prompt targeted antimicrobial therapy.

Rev Esp Quimioter 2019; 32(3):246-253 [Texto completo PDF]