Efficient use of the BioFire® FilmArray® Meningitis/Encephalitis Panel: a diagnostic stewardship approach

Abstract Background The BioFire® FilmArray® Meningitis/Encephalitis Panel (FA/ME) (BioFire Diagnostics, LLC, Salt Lake City, UT, USA) is a multiplex polymerase chain reaction (PCR) assay which detects pathogens causing community‐acquired meningitis/encephalitis. Aims This study aimed to evaluate the performance, clinical impact and potential of a diagnostic stewardship algorithm to optimise FA/ME use in an Australian tertiary hospital. Methods This retrospective study evaluated microbiological data from 712 patients who underwent FA/ME testing between July 2018 and April 2024 at the Royal Melbourne Hospital and clinical data from a subset of 439 patients. Results The FA/ME positivity rate was 12. 2%. The panel showed 69. 70% sensitivity and 93. 04% specificity compared with comparator methods. FA/ME positivity was associated with targeted antimicrobial therapy and shorter hospital stays. The cerebrospinal fluid white cell count (WCC) strongly predicted FA/ME positivity (area under the curve = 0. 80, P 50 × 10 6 /L for FA/ME testing, with reflex testing of specimens with lower WCC on an alternative viral multiplex PCR, would have reduced annual costs from 23 302 (without stewardship) to 14 646, doubled the positivity rate to 29. 54% and detected all clinically significant infections. This study provides insights into optimising FA/ME use in Australia to improve patient management.