Ritu Banerjee, MD, PhD
Vanderbilt University Medical Center
Disclosure: Accelerate Diagnostics: Grant/Research Support
BioFire: Research Grant
Biomerieux: Research Grant
Roche: Research Grant
Background : The clinical benefits of multiplex polymerase chain reaction panels are not well defined. We evaluated outcomes among infants before and after implementation of the BioFire® FilmArray® Respiratory Panel 2 (RP2) and Meningitis Encephalitis Panel (MEP).
Methods : This single center study compared outcomes among infants ≤ 90 days presenting to the Emergency Department with fever (T≥ 38.0°C) or hypothermia (T< 35.8°C) during 3 time periods. P1 (1/1/2011-12/31/2014) had batch testing using a Genmark Dx® respiratory viral panel (RVP) and no standardized clinical practice guideline (CPG); P2 (1/1/2015-4/30-2018) had the RVP and a CPG; and P3 (5/1/2018-3/31/2019) had on-demand RP2 and MEP testing and a CPG. Clinical data were collected from medical records. Statistical analyses were performed using Kruskal-Wallis and Pearson tests.
There were 5195 total patients: 2514 in P1, 2082 in P2, 599 in P3. Groups did not differ in pathogens or antimicrobials used. Testing was faster and performed more commonly in P3 than P1 or P2 (P1, 10%; P2, 6.9%; P3, 71%; Table 1). From P1 to P3 there were significant decreases in length of stay (LOS), % receiving antimicrobials, antibiotic durations, ancillary test use, lumbar punctures (LPs), and chest X-rays (Table 1). In P3 compared to P2, infants more commonly received no antimicrobials (43.1% vs. 32.4%, p< 0.001; Figure 1), had fewer median (IQR) number of ancillary tests (5 (5-8) vs. 7 (3-10); p< 0.001), and shorter median (IQR) days of antibiotics (2.0 (1.0-2.7) vs. 2.4 (1.1-3.4); p< 0.001; Table 1).
Among P3 infants, those with positive RP2 and/or MEP results were less likely to receive antimicrobials, be hospitalized or readmitted, had fewer ancillary tests and LPs, and shorter LOS and antibiotic durations than those with negative tests (Table 2).
Conclusion : In this large pre-post intervention study among infants ≤ 90 days with fever or hypothermia, a clinical guideline plus rapid testing with RP2 and MEP was associated with less antimicrobial use and ancillary testing than a clinical guideline alone. Infants with positive RP2 and/or MEP results had fewer admissions, shorter LOS, and less antimicrobial and ancillary test use than those with negative tests. Rapid pathogen testing has benefit for infants.