Impact of CSF Meningitis and Encephalitis Panel on Resource Use for Febrile Well-Appearing Infants

Abstract

OBJECTIVES To determine whether the BioFire FilmArray Meningitis/Encephalitis (ME) panel is associated with decreased resource use for febrile infants. The ME panel has a rapid turnaround time (1–2 hours) and may shorten length of stay (LOS) and antimicrobial use for febrile well-appearing infants. METHODS Retrospective cohort study of febrile well-appearing infants ≤60 days with cerebrospinal fluid culture sent in the emergency department from July 2017 to April 2019. We examined the frequency of ME panel use and its relationship with hospital LOS and initiation and duration of antibiotics and acyclovir. We used nonparametric tests to compare median durations. RESULTS The ME panel was performed for 85 (36%) of 237 infants. There was no difference in median hospital LOS for infants with versus without ME panel testing (42 hours, interquartile range [IQR] 36–52 vs 40 hours, IQR: 35–47, P = .09). More than 97% of infants with and without ME panel testing were initiated on antibiotics. Patients with ME panel were more likely to receive acyclovir (33% vs 18%; odds ratio: 2.2, 95%: confidence interval 1.2–4.0). There was no difference in median acyclovir duration with or without ME panel testing (1 hour, IQR: 1–7 vs 4.2 hours, IQR: 1–21, P = .10). When adjusting for potential covariates, these findings persisted. CONCLUSIONS ME panel use was not associated with differences in hospital LOS, antibiotic initiation, or acyclovir duration in febrile well-appearing infants. ME panel testing was associated with acyclovir initiation.