Does cerebrospinal fluid multiplex polymerase chain reaction meningitis panel help manage children with meningitis?

TL;DR

This study evaluates how a cerebrospinal fluid multiplex PCR test helps diagnose and manage meningitis in children, finding it improves speed and accuracy.

Contribution

The study evaluates the clinical utility of a CSF multiplex PCR panel in pediatric meningitis management.

Findings

CSF multiplex PCR identified pathogens in antibiotic-pretreated patients with negative cultures.

Viral meningitis diagnosis led to quicker discontinuation of antibiotics and shorter hospital stays.

The test was particularly effective in infants and when CSF samples were inadequate for traditional analysis.

Abstract

Meningitis has significant clinical morbidity and mortality in children. Mortality in children, especially neonates, is high due to diagnostic difficulty. Diagnosis of pediatric meningitis is traditionally made using CSF parameters and cultures. The performance of cerebrospinal fluid (CSF) multiplex polymerase chain reaction (PCR) meningitis panel needs further evaluation in the pediatric population.

Medical records of children with a positive CSF multiplex panel (June 1, 2016 to August 31, 2018) were reviewed retrospectively. We extracted data about antimicrobials used, laboratory and culture results, duration of antibiotic treatment and hospital stay.

A total of 79 children (age, 1 d to 12 y) were identified, including 58 children with viral (73%) and 21 children (27%) with bacterial meningitis. The most frequent viruses were enterovirus in all age groups. Empiric antibiotics were discontinued within 24 h in 14 of 40 patients (35%) positive for viral meningitis. Specific antiviral therapy was rapidly initiated in 6 out of 58 patients (10%). Antibiotics were stopped or never initiated when viral etiology was identified. Even when the CSF sample was inadequate for analysis, the pathogenic organism was identified particularly helpful in the infants. In antibiotic pretreated patients, the organism was identified even when the cultures were negative. CSF multiplex panel identified 13 patients who had bacterial meningitis despite negative CSF cultures. Twelve of these 13 patients (92%) were pretreated with antibiotics. Modification of antibiotic therapy was never the result of CSF multiplex panel. Duration of antibiotic treatment and hospital stay were substantially shorter in patients with viral as opposed to bacterial meningitis.

CSF multiplex panel saves brain as it is rapid, specific, and highly sensitive. It also reduces the healthcare cost, and its use is highly recommended in a pediatric population.