Clinical utility of a cerebrospinal fluid multiplex PCR meningitis/encephalitis panel in children: a retrospective review of positive results

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/encephalitis (ME) panel needs further evaluation in the pediatric population. Medical records of children with a positive CSF ME 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, hospital stay, and follow-up. Long term outcome was evaluated. 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 which is particularly helpful in the infants. In antibiotic pretreated patients, the organism was identified even when the cultures were negative. CSF ME panel identified 13 patients who had bacterial meningitis despite negative CSF cultures. Twelve of these 13 patients (92%) were pretreated with antibiotics. In bacterial meningitis cases, modification of antibiotic therapy was not based solely on the result of CSF ME panel. Duration of antibiotic treatment and hospital stay were substantially shorter in patients with viral as opposed to bacterial meningitis. Delay in diagnosis and targeted antimicrobial therapy may worsen neurologic outcomes. CSF ME panel may enable earlier targeted therapy and reduce unnecessary antimicrobial exposure as it is rapid, specific, and highly sensitive. It is expected to reduce healthcare cost, and its use is recommended in a pediatric population.