Clinical and Financial Impact of a Diagnostic Stewardship Program for Children with Suspected Central Nervous System Infection - 06/05/22
, Claire Palmer, MS 1, LiseAnne Gregoire 2, Audrey Elliott 2, Elizabeth Ackley, MD 3, Marcelo C. Perraillon, PhD 4, Kenneth L. Tyler, MD 5, Samuel R. Dominguez, MD 1, 2Abstract |
Objective |
To investigate the optimal implementation and clinical and financial impacts of the FilmArray Meningitis Encephalitis Panel (MEP) multiplex polymerase chain reaction testing of cerebrospinal fluid (CSF) in children with suspected central nervous system infection.
Study design |
A pre–post quasiexperimental cohort study to investigate the impact of implementing MEP using a rapid CSF diagnostic stewardship program was conducted at Children's Hospital Colorado (CHCO). MEP was implemented with electronic medical record indication selection to guide testing to children meeting approved use criteria: infants <2 months, immunocompromised, encephalitis, and ≥5 white blood cells/μL of CSF. Positive results were communicated with antimicrobial stewardship real-time decision support. All cases with CSF obtained by lumbar puncture sent to the CHCO microbiology laboratory meeting any of the 4 aforementioned criteria were included with preimplementation controls (2015-2016) compared with postimplementation cases (2017-2018). Primary outcome was time-to-optimal antimicrobials compared using log-rank test with Kaplan–Meier analysis.
Results |
Time-to-optimal antimicrobials decreased from 28 hours among 1124 preimplementation controls to 18 hours (P < .0001) among 1127 postimplementation cases (72% with MEP testing conducted). Postimplementation, time-to-positive CSF results was faster (4.8 vs 9.6 hours, P < .0001), intravenous antimicrobial duration was shorter (24 vs 36 hours, P = .004), with infectious neurologic diagnoses more frequently identified (15% vs 10%, P = .03). There were no differences in time-to-effective antimicrobials, hospital admissions, antimicrobial starts, or length of stay. Costs of microbiologic testing increased, but total hospital costs were unchanged.
Conclusions |
Implementation of MEP with a rapid central nervous system diagnostic stewardship program improved antimicrobial use with faster results shortening empiric therapy. Routine MEP testing for high-yield indications enables antimicrobial optimization with unchanged overall costs.
Le texte complet de cet article est disponible en PDF.Key words : meningitis, encephalitis, rapid diagnostics, diagnostic stewardship, central nervous system infection
Abbreviations : CHCO, CNS, CSF, HHV-6, HPeV, HSV, LP, MEP, PCR, VZV, WBC
Plan
| Funded by the National Institute of Allergy and Infectious Diseases (grant K23AI28069). Research was supported by National Institutes of Health/National Center for Advancing Translational Sciences, Colorado Clinical and Translational Sciences Institute Grant Number UL1 TR002535. The contents of this article are the authors' sole responsibility and do not necessarily represent official views of the National Institutes of Health. S.D. serves as a consultant for BioFire Diagnostics, Diasorin, and Karius and receives grant support separate from this study from Biofire Diagnostics. BioFire had no role in the funding, design, or write-up of this study. The other authors declare no conflicts of interest. |
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| Portions of this study were presented as poster/abstract during the IDWeek meeting, on October 2, 2021, Virtual Meeting. |
Vol 244
P. 161 - mai 2022 Retour au numéro
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