1398. Clinical Performance of Film Array Meningitis/Encephalitis Multiplex PCR Panel in CNS Infection

Abstract

Background Rapid identification of pathogen is important in the management of meningoencephalitis. A fully-automated multiplex PCR, the FilmArray (FA) meningitis/encephalitis (ME) panel, detects 14 pathogens simultaneously in an hour. As there is not much data on this, we undertook this study to understand its performance. Methods A retrospective analysis was done on patients, both adult and pediatric, admitted with meningitis/encephalitis syndrome between December 2016 and 2018 and who underwent the FA–ME panel (BioFire Diagnostics, USA) multiplex PCR test on CSF. The performance of the FA- ME panel was compared with that of routine tests done on CSF which is cell count, biochemistry, gram stain, bacterial culture, and other relevant tests. Results FA- ME panel was done in 259 patients and it detected pathogen in 61 (23.6%) patients with ME syndrome. Viruses accounted for 70.4%, bacteria 24.5%, and 2 patients had 2 organisms in a single sample (enterovirus and H. influenzae on both occasions). Enterovirus was the commonest accounting for 29 cases, followed by varicella in 11, pneumococci in 9. HHV 6, H. influenzae , Strep agalactiae and Listeria were the rest. Enterovirus meningitis showed seasonal prevalence; 24 out of 29 cases occurred during October till December. CSF bacterial culture yield was low, positive only in 8 (3%) cases and matched with FA ME panel in one sample which grew pneumococci; 7 other cultures grew either Gram-negative pathogens, rare organisms/ contaminants not included in FA ME panel. CNS tuberculosis was diagnosed in 6, 7 patients had aseptic meningitis due to tropical infections, 5 of which were dengue fever, 2 were scrub typhus. Overall, 191 patients (73.7%) were treated as CNS infection through FA ME panel were negative in 130 of these, rest had alternative diagnosis. Antibiotic de-escalation was better in the group with positive FA ME panel result. Conclusion FA-ME panel has better diagnostic yield compared with culture (26.3% vs. 3%). Viruses were commoner and majority were enteroviruses showing seasonal prevalence. Those bacteria that grew in CSF culture but not identified by FA ME panel were Gram-negative or unusual pathogens. Additional tests need to be used when considering post-traumatic or nosocomial meningitis, tuberculosis, and tropical infections. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]