Impact of cerebrospinal fluid syndromic testing in the management of children with suspected central nervous system infection

Eur J Clin Microbiol Infect Dis. 2020 Dec;39(12):2379-2386. doi: 10.1007/s10096-020-03986-6. Epub 2020 Jul 18.


The aim of the study was to evaluate the impact of the use of BioFire® FilmArray® meningitis/encephalitis(FA-ME) panel which enables rapid automated CSF testing for 14 common viral, bacterial, and yeast pathogens that cause CNS infections, in the management of children with suspected CNS infection. A prospective cohort study was performed on children admitted to a tertiary pediatric hospital, over a period of 1 year, with possible CNS infection and CSF pleocytosis (> 15 cells/mm3). Children were randomized 1:1, either to use FA-ME or separate molecular CSF microbiological tests according to usual pediatric practice in the hospital. Length of hospital stay, duration of antimicrobials, and total cost of hospitalization were compared between groups. A total of 142 children were included in the study (71 cases). A pathogen was detected in 37/71(52.1%) children with the use of FA-ME and in 16/71(22.5%) in the control group (P value < 0.001). In aseptic meningitis cases a virus was detected in 27/61(44.2%) and in 11/66(16.7%) controls (P value < 0.001). Median (IQR) length of stay in cases and controls with aseptic meningitis was 5(4-8) and 8(6-10) days, respectively (P value < 0. 001). The median (IQR) duration of antimicrobials in cases and controls was 4(2-5.7) and 7(5-10) days, respectively (P value < 0.001). The hospitalization cost was calculated in cases and controls 1042€ (932-1372) and 1522€ (1302-1742), respectively (P value < 0.001). The use of FA-ME was able to reduce significantly the use of antimicrobials, the hospitalization days, and the total cost comparing to the control group in children with suspected CNS infection.

Keywords: Antibiotics; Aseptic; Cost; Encephalitis; FilmArray; Meningitis; PCR.

MeSH terms

  • Adolescent
  • Bacteria / isolation & purification
  • Central Nervous System Infections / cerebrospinal fluid
  • Central Nervous System Infections / diagnosis
  • Central Nervous System Infections / epidemiology
  • Cerebrospinal Fluid / microbiology*
  • Cerebrospinal Fluid / virology*
  • Child
  • Child, Preschool
  • Diagnostic Tests, Routine
  • Encephalitis / cerebrospinal fluid
  • Encephalitis / diagnosis*
  • Encephalitis / epidemiology
  • Female
  • Greece
  • Hospitalization / economics
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Meningitis / cerebrospinal fluid
  • Meningitis / diagnosis*
  • Meningitis / epidemiology
  • Multiplex Polymerase Chain Reaction
  • Prospective Studies
  • Viruses / isolation & purification