University of South Alabama Children's and Women's Hospital, Alabama
Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Supatida Tengsupakul, MD – Associate Professor of Pediatrics, University of South Alabama Co-Author: Madhuri Mulekar, Ph.D – Professor of Mathematics and Statistics, University of South Alabama Co-Author: Bibek Bista, MBBS, MPH – Assistant Professor, McGovern Medical School at the University of Texas Health Science Center at Houston Co-Author: Paul Maertens, MD – Professor of Neurology, University of South Alabama
Introduction: Meningitis has significant clinical morbidity and even mortality in children. Mortality in children, especially neonates, is high due to diagnostic difficulty. Diagnosis of pediatric meningitis is made earlier with cerebrospinal fluid (CSF) multiplex polymerase chain reaction (PCR) compared to CSF culture report.
Methods: Medical records of children with a positive FilmArray ME Panel from June 1, 2016 to August 31, 2018 are retrospectively reviewed from the Microbiology laboratory database. Extracted data included antimicrobials used, antibiotic treatment duration, length of hospital stay, biomarker and culture results.
Results: 79 children had a positive CSF ME panel (age: median, 38 d; range, 1 d to 12 y), and, among them, 58 children (73%; median 35 d; range, 1 d to 12 y) had viral meningitis, and 21 children (27%) (median: 53 d, range, 2 d to 3.5 y) had bacterial meningitis. The most frequent viruses were enterovirus in all age groups. The most common bacterial causes were S. agalactiae in < 30 d, E. Coli in 30-90 d, and H. influenzae in > 90 d age groups. Empiric antibiotics were discontinued within 24 h in 14 of 40 patients (35%) with viral meningitis and modified in 10 of 21 patients (48%) with bacterial meningitis. Patients with viral meningitis had lower serum C-reactive protein levels (viral, 2 ± 3 mg/dL; bacterial, 9 ± 8 mg/dL, P = 0.0003). CSF PCR identified 14 patients who had bacterial meningitis but negative CSF cultures.
Conclusions: A positive CSF ME panel is useful in identifying organisms causing pediatric meningitis and enables early modification of empiric antimicrobial therapy. ME panel decreases length of stay and antibiotic use for febrile well-appearing infants.
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