Maheswari Ekambaram1, Aleisha Nabower2, Prabi Rajbhandari3, Jaclyn Eisenberg4, Nathaniel Goodrich2, Krow Ampofo5, Nathan S Gollehon2, Kimberly C Martin6, Elizabeth Lyden7, Jessica Snowden8. 1. Department of Pediatrics, Baylor Scott and White Medical Center, Round Rock, Texas, USA. 2. Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA. 3. Division of Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio, USA. 4. Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Chicago Medical Center, Chicago, Illinois, USA. 5. Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA. 6. Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA. 7. Department of Biostatistics, University of Nebraska College of Public Health, Omaha, Nebraska, USA. 8. Department of Pediatrics, University of Arkansas Medical Center, Little Rock, Arkansas, USA.
Abstract
BACKGROUND: The FilmArray Meningitis/Encephalitis panel (MEP) has an 11% false-positive and 2.2% false-negative rate compared with conventional testing. We describe clinical characteristics, treatment decisions, and outcomes in children with discordant results between MEP and conventional testing. METHODS: We conducted a multisite review of patients ≤ 18 years with suspected central nervous system infection and positive results by MEP or conventional testing (cerebrospinal fluid [CSF] culture, herpes simplex virus [HSV] polymerase chain reaction (PCR), and enterovirus [EV] PCR). Descriptive results are provided for patients with discordant results. Comparison between group 1 (MEP and CSF culture positive) and group 2 (MEP positive, CSF culture negative, or showing a different pathogen) was made by Mann-Whitney test for continuous and Fisher's test for categorical variables. RESULTS: A total of 355 patients had at least one pathogen identified. More than half of patients with bacterial pathogens identified that are included in the MEP had discordant results (30/52; 58%). There were 28 samples with bacterial pathogen identified on MEP only, 1 with different bacterial pathogens on MEP and culture, and 1 with Escherichia coli identified on CSF culture only. Patients in group 1 were more likely to have CSF pleocytosis, elevated CSF protein, and decreased CSF glucose than group 2 (P < .05). Two patients were HSV positive by MEP while HSV negative by PCR. Ten patients had discordant results between MEP and EV PCR. CONCLUSIONS: Discordant results between MEP and conventional testing are common. Treatment decisions based on a positive MEP should be made in the appropriate clinical context.
BACKGROUND: The FilmArray Meningitis/Encephalitis panel (MEP) has an 11% false-positive and 2.2% false-negative rate compared with conventional testing. We describe clinical characteristics, treatment decisions, and outcomes in children with discordant results between MEP and conventional testing. METHODS: We conducted a multisite review of patients ≤ 18 years with suspected central nervous system infection and positive results by MEP or conventional testing (cerebrospinal fluid [CSF] culture, herpes simplex virus [HSV] polymerase chain reaction (PCR), and enterovirus [EV] PCR). Descriptive results are provided for patients with discordant results. Comparison between group 1 (MEP and CSF culture positive) and group 2 (MEP positive, CSF culture negative, or showing a different pathogen) was made by Mann-Whitney test for continuous and Fisher's test for categorical variables. RESULTS: A total of 355 patients had at least one pathogen identified. More than half of patients with bacterial pathogens identified that are included in the MEP had discordant results (30/52; 58%). There were 28 samples with bacterial pathogen identified on MEP only, 1 with different bacterial pathogens on MEP and culture, and 1 with Escherichia coli identified on CSF culture only. Patients in group 1 were more likely to have CSF pleocytosis, elevated CSF protein, and decreased CSF glucose than group 2 (P < .05). Two patients were HSV positive by MEP while HSV negative by PCR. Ten patients had discordant results between MEP and EV PCR. CONCLUSIONS: Discordant results between MEP and conventional testing are common. Treatment decisions based on a positive MEP should be made in the appropriate clinical context.