Meningitis/Encephalitis FilmArray® Use Widespread Despite Lack of Guidelines

US clinicians reported widespread use of the Meningitis/Encephalitis FilmArray® panel despite a lack of institutional guidelines.

Results of an online cross-sectional survey of clinicians in the United States found widespread use of the Meningitis/Encephalitis FilmArray® panel despite a lack of institutional guidelines on its use or interpretation of its results. These study findings were published in BMC Infectious Diseases.

This survey was distributed via the American Academy of Pediatrics Section of Hospital Medicine, Brown University Pediatric Emergency Medicine, and Pediatric Intensive Care Unit Virtual Pediatric System (VPS) listservs. Clinicians were surveyed about their use of the panel, availability of guidelines about the panel, and how they might respond in various clinical scenarios.

A total of 331 clinicians across 177 US hospitals completed the survey. Of these clinicians, most were physicians (97.5%), and the majority were employed at a university-affiliated children’s hospital (58.3%) as pediatric hospital medicine providers (51.2%). In addition, 39% of the clinicians had practiced for more than 10 years.

Survey results showed 268 (68%) clinicians reported use of the panel, with few (8%) using it for more than 4 years. Clinicians reported receipt of panel results within 3 (52%) or 6 (78%) hours of testing. Longer wait times for results were found to be significantly associated with sending the tests out for processing at another site (P =.001).

The majority of clinicians reported having no institutional guidelines on use of the panel (75%) or interpretation of its results (76%). No trends in the availability of guidelines were observed on the basis of institution type.

Stratified by the availability of guidelines, clinicians employed at institutions with guidelines on appropriate panel use had greater levels self-reported knowledge about the diagnostic performance of the panel vs those at institutions without guidelines (51% vs 38%; P =.01).

Given the clinical scenario of a child (age, 4 years) who tested positive for bacterial meningitis via the panel and was exhibiting clinical features inconsistent with meningitis, 83% of clinicians reported they would start the patient on antibiotic therapy. This percentage increased to 95% for a scenario in which the patient had a cerebrospinal fluid (CSF) cell count suggestive of meningitis, with 45% of clinicians reporting they would switch the patient to narrow-spectrum antibiotic therapy without evaluating additional culture results.

[F]urther research is needed to fully evaluate ME panel use variability.

For a 3-week-old infant with fever with no symptoms suggestive of bacterial meningitis, 36% of clinicians reported they would discontinue antibiotic therapy if panel results were positive for a viral pathogen. This percentage increased by 21% for a scenario in which this patient’s CSF cell count were within the reference range.

These study results may not reflect real-world clinical scenarios. Other study limitations include potentially limited generalizability, particularly among pediatric intensive care and infectious disease physicians.

“The majority of providers in our study were not aware of guidelines regarding the ME [Meningitis/Encephalitis FilmArray] panel test,” the researchers noted. “[F]urther research is needed to fully evaluate ME panel use variability,” they concluded.

References:

Rajbhandari P, Goodrich N, Nabower AM, et al. Current state and practice variation in the use of Meningitis/Encephalitis (ME) FilmArray panel in children. BMC Infect Dis. 2022;22(1):811. doi:10.1186/s12879-022-07789-2