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Impact of a multiplex PCR assay (FilmArray®) on the management of patients with suspected central nervous system infections

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Abstract

Microbiological diagnosis of central nervous system (CNS) infections is challenging due to limited access to CNS samples, overlap between meningitis and encephalitis, and the multiplicity of pathogens potentially involved. We aimed to estimate the impact of a commercial multiplex PCR assay (FilmArray® meningitis/encephalitis) on the management of patients with suspicion of meningitis or encephalitis, in terms of time to diagnosis, antimicrobial agents use, duration of hospitalization, and costs. This prospective observational study was conducted at Saint Joseph Hospital (Paris, France) from December 2016 to December 2017. All CSF samples sent to the microbiology laboratory for suspicion of meningitis and/or encephalitis, with CSF cells count > 5 cells/μL, were tested by meningitis/encephalitis multiplex PCR assay. One hundred thirty patients were included. The multiplex PCR assay was positive in 33 patients (25%). Main pathogens found were Enterovirus (n = 12), Varicella-Zoster virus (n = 7), Herpes simplex virus-2 (n = 6), and Listeria monocytogenes (n = 3) as main pathogens. The multiplex PCR assay reduced time to microbiological diagnosis by 3.3 ± 1.6 days and allowed an earlier discontinuation of empirical anti-infective drugs in 42 patients (32%) and an earlier hospital discharge in 23 patients (18%), with an estimated saving of 82 hospital days overall, and a management cost reduction of 26,242 € (201 €/patient). The systematic use of the FilmArray® meningitis/encephalitis multiplex PCR assay may allow earlier diagnosis, earlier discontinuation of empirical treatment, reduced duration of stay, and costs reduction.

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Change history

  • 28 August 2021

    The name of the 5th author Jean-Claude Nguyen Van was incorrectly tagged.This has been updated and correctly captured as GivenName: Jean-Claude and FamilyName: Nguyen Van.

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Author notes

  1. Marine Cailleaux and Benoît Pilmis contributed equally to this work.

Authors and Affiliations

  1. Service de Maladies Infectieuses, CHU de Rennes, Rennes, France

    Marine Cailleaux & Pierre Tattevin

  2. Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France

    Marine Cailleaux, Benoît Pilmis, Carine Couzigou & Barbara Vidal

  3. EA4043 Unité Bactéries Pathogènes et Santé (UBaPS), Université Paris-Sud Paris Saclay, Chatenay-Malabry, Paris, France

    Benoît Pilmis, Assaf Mizrahi & Alban Le Monnier

  4. Laboratoire de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France

    Assaf Mizrahi, Julie Lourtet-Hascoet & Jean-Claude Nguyen Van

  5. Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France

    Lilian Alix

Authors
  1. Marine Cailleaux
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  2. Benoît Pilmis
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  3. Assaf Mizrahi
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  4. Julie Lourtet-Hascoet
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  5. Jean-Claude Nguyen Van
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  6. Lilian Alix
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  7. Carine Couzigou
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  8. Barbara Vidal
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  9. Pierre Tattevin
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  10. Alban Le Monnier
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Correspondence to Benoît Pilmis.

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The authors declare that they have no conflict of interest.

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This study was approved by the Saint Joseph Hospital institutional ethical board.

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Cailleaux, M., Pilmis, B., Mizrahi, A. et al. Impact of a multiplex PCR assay (FilmArray®) on the management of patients with suspected central nervous system infections. Eur J Clin Microbiol Infect Dis 39, 293–297 (2020). https://doi.org/10.1007/s10096-019-03724-7

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  • DOI: https://doi.org/10.1007/s10096-019-03724-7

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