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Comparison of antibiotic and acyclovir usage before and after the implementation of an on-site FilmArray meningitis/encephalitis panel in an academic tertiary pediatric hospital: a retrospective observational study
Prompt initiation of empiric therapy is common practice in case of suspected meningitis or encephalitis. However, in children the most common pathogens are viruses that usually do not require and are not covered by the applied anti-infective treatment. Novel multiplex PCR (mPCR) panels provide rapid...
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| Published in: | BMC pediatrics 2020-02, Vol.20 (1), p.56-56, Article 56 |
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| description | Prompt initiation of empiric therapy is common practice in case of suspected meningitis or encephalitis. However, in children the most common pathogens are viruses that usually do not require and are not covered by the applied anti-infective treatment. Novel multiplex PCR (mPCR) panels provide rapid on-site diagnostic testing for a variety of pathogens. This study compared empiric antibiotic and acyclovir usage before and after the introduction of an on-site FilmArray Meningitis/Encephalitis Panel (FA ME Panel).
We retrospectively compared data for empiric antibiotic and acyclovir usage between pediatric patients with suspected central nervous system (CNS) infection receiving mPCR testing and a matched historical control group. Patients were matched by age and suspected CNS infection. We included all patients for whom empiric antibiotics and/or acyclovir were prescribed.
Each study group consisted of 46 patients with 29 (63.0%) infants and 17 (37.0%) older children. A viral pathogen was diagnosed in 5/46 (10.9%) patients in the control group (all enteroviruses) and in 14/46 (30.4%) patients in the mPCR group (enterovirus n = 9; human herpesvirus 6 (HHV-6) n = 5), (p = 0.038)). Length of Therapy (LoT) and Days of Therapy (DoT) for antibiotics were significantly lower for infants (4.0 vs. 3.0, p = 0.038 and 8.0 vs. 6.0, p = 0.015, respectively). Acyclovir therapy was significantly shorter for both, infants and older children (3.0 vs. 1.0 day, p |
| doi_str_mv | 10.1186/s12887-020-1944-2 |
| format | article |
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We retrospectively compared data for empiric antibiotic and acyclovir usage between pediatric patients with suspected central nervous system (CNS) infection receiving mPCR testing and a matched historical control group. Patients were matched by age and suspected CNS infection. We included all patients for whom empiric antibiotics and/or acyclovir were prescribed.
Each study group consisted of 46 patients with 29 (63.0%) infants and 17 (37.0%) older children. A viral pathogen was diagnosed in 5/46 (10.9%) patients in the control group (all enteroviruses) and in 14/46 (30.4%) patients in the mPCR group (enterovirus n = 9; human herpesvirus 6 (HHV-6) n = 5), (p = 0.038)). Length of Therapy (LoT) and Days of Therapy (DoT) for antibiotics were significantly lower for infants (4.0 vs. 3.0, p = 0.038 and 8.0 vs. 6.0, p = 0.015, respectively). Acyclovir therapy was significantly shorter for both, infants and older children (3.0 vs. 1.0 day, p < 0.001 for both age groups).
The findings of our study suggest that the introduction of a FA ME Panel into clinical routine procedures is associated with a significantly reduced LoT and DoT of empiric anti-infective treatment in children with suspected meningoencephalitis. The largest effect was observed in infants.</description><identifier>ISSN: 1471-2431</identifier><identifier>EISSN: 1471-2431</identifier><identifier>DOI: 10.1186/s12887-020-1944-2</identifier><identifier>PMID: 32020860</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Acyclovir ; Acyclovir - therapeutic use ; Adolescent ; Age ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Antimicrobial agents ; Antimicrobial stewardship ; Antiviral drugs ; Bacterial infections ; Central nervous system ; Child ; Child health ; Child, Preschool ; Children's hospitals ; Diagnosis ; Drug therapy ; Electronic health records ; Encephalitis ; Encephalitis - drug therapy ; Female ; FilmArray ; Herpes viruses ; Hospitals ; Hospitals, Pediatric ; Humans ; Infant ; Infants ; Infection ; Laboratories ; Male ; Medical records ; Medical research ; Medical tests ; Meningitis ; Meningitis - drug therapy ; Meningoencephalitis ; Methods ; mPCR ; Novels ; Observational studies ; Onsite ; Pathogenic microorganisms ; Pathogens ; Patients ; Pediatric diseases ; Pediatric research ; Pediatrics ; Polymerase chain reaction ; Retrospective Studies ; Streptococcus infections ; Virology ; Young Adult</subject><ispartof>BMC pediatrics, 2020-02, Vol.20 (1), p.56-56, Article 56</ispartof><rights>COPYRIGHT 2020 BioMed Central Ltd.</rights><rights>2020. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s). 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c591t-ec86a51e9061cba68d7ae4da9c34fbc2d2e234037e7918fe6ac2263080df784b3</citedby><cites>FETCH-LOGICAL-c591t-ec86a51e9061cba68d7ae4da9c34fbc2d2e234037e7918fe6ac2263080df784b3</cites><orcidid>0000-0003-1232-4646</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001287/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2357506170?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32020860$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hagen, Alexandra</creatorcontrib><creatorcontrib>Eichinger, Anna</creatorcontrib><creatorcontrib>Meyer-Buehn, Melanie</creatorcontrib><creatorcontrib>Schober, Tilmann</creatorcontrib><creatorcontrib>Huebner, Johannes</creatorcontrib><title>Comparison of antibiotic and acyclovir usage before and after the implementation of an on-site FilmArray meningitis/encephalitis panel in an academic tertiary pediatric hospital: a retrospective observational study</title><title>BMC pediatrics</title><addtitle>BMC Pediatr</addtitle><description>Prompt initiation of empiric therapy is common practice in case of suspected meningitis or encephalitis. However, in children the most common pathogens are viruses that usually do not require and are not covered by the applied anti-infective treatment. Novel multiplex PCR (mPCR) panels provide rapid on-site diagnostic testing for a variety of pathogens. This study compared empiric antibiotic and acyclovir usage before and after the introduction of an on-site FilmArray Meningitis/Encephalitis Panel (FA ME Panel).
We retrospectively compared data for empiric antibiotic and acyclovir usage between pediatric patients with suspected central nervous system (CNS) infection receiving mPCR testing and a matched historical control group. Patients were matched by age and suspected CNS infection. We included all patients for whom empiric antibiotics and/or acyclovir were prescribed.
Each study group consisted of 46 patients with 29 (63.0%) infants and 17 (37.0%) older children. A viral pathogen was diagnosed in 5/46 (10.9%) patients in the control group (all enteroviruses) and in 14/46 (30.4%) patients in the mPCR group (enterovirus n = 9; human herpesvirus 6 (HHV-6) n = 5), (p = 0.038)). Length of Therapy (LoT) and Days of Therapy (DoT) for antibiotics were significantly lower for infants (4.0 vs. 3.0, p = 0.038 and 8.0 vs. 6.0, p = 0.015, respectively). Acyclovir therapy was significantly shorter for both, infants and older children (3.0 vs. 1.0 day, p < 0.001 for both age groups).
The findings of our study suggest that the introduction of a FA ME Panel into clinical routine procedures is associated with a significantly reduced LoT and DoT of empiric anti-infective treatment in children with suspected meningoencephalitis. The largest effect was observed in infants.</description><subject>Acyclovir</subject><subject>Acyclovir - therapeutic use</subject><subject>Adolescent</subject><subject>Age</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial stewardship</subject><subject>Antiviral drugs</subject><subject>Bacterial infections</subject><subject>Central nervous system</subject><subject>Child</subject><subject>Child health</subject><subject>Child, Preschool</subject><subject>Children's hospitals</subject><subject>Diagnosis</subject><subject>Drug therapy</subject><subject>Electronic health records</subject><subject>Encephalitis</subject><subject>Encephalitis - drug therapy</subject><subject>Female</subject><subject>FilmArray</subject><subject>Herpes viruses</subject><subject>Hospitals</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Infant</subject><subject>Infants</subject><subject>Infection</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical records</subject><subject>Medical research</subject><subject>Medical tests</subject><subject>Meningitis</subject><subject>Meningitis - drug therapy</subject><subject>Meningoencephalitis</subject><subject>Methods</subject><subject>mPCR</subject><subject>Novels</subject><subject>Observational studies</subject><subject>Onsite</subject><subject>Pathogenic microorganisms</subject><subject>Pathogens</subject><subject>Patients</subject><subject>Pediatric diseases</subject><subject>Pediatric research</subject><subject>Pediatrics</subject><subject>Polymerase chain reaction</subject><subject>Retrospective Studies</subject><subject>Streptococcus infections</subject><subject>Virology</subject><subject>Young Adult</subject><issn>1471-2431</issn><issn>1471-2431</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptU8Fu1DAQjRCIlsIHcEGWkBCXtLHjjb0ckFYrCpUqcYGzNbEnu145cbCdlfZH-R6cblu6iJPt8Xtvxm88RfGWVpeUyuYqUialKCtWlXTJecmeFeeUC1oyXtPnT_ZnxasYd1VFheTNy-KsZpkjm-q8-L32_QjBRj8Q3xEYkm2tT1bnrSGgD9r5vQ1kirBB0mLnAx6vuoSBpC0S248OexwSJPugQvxQRpuQXFvXr0KAA8kIO2xssvEKB43jFtx8ICMM6IgdZhZoMNjn5Fk7WQgHMqKxkEIObX0cbQL3iQAJmEI-ok52j8S3EcP-Ljs4EtNkDq-LFx24iG_u14vi5_WXH-tv5e33rzfr1W2pF0uaStSygQXFZdVQ3UIjjQDkBpa65l2rmWHIal7VAsWSyg4b0Iw1dSUr02Ur2_qiuDnqGg87NQbb56KVB6vuAj5sFOSXaIeK10IvDUgw0HFuupaLmgqOTLSU6way1uej1ji1PRqdHQ3gTkRPbwa7VRu_VyI3lkmRBT7eCwT_a8KYVG-jRueyw36KitULymUjF4sMff8PdOenkO27Q4lF9kNUf1EbyA-wQ-dzXj2LqlVDG84opTyjLv-DemilH7CzOX5C-PCEsEVwaRu9m-YGxlMgPQJ17nYM2D2aQSs1T4A6ToDKv1nNE5CLvyjePXXxkfHw5es_3-QF9g</recordid><startdate>20200205</startdate><enddate>20200205</enddate><creator>Hagen, Alexandra</creator><creator>Eichinger, Anna</creator><creator>Meyer-Buehn, Melanie</creator><creator>Schober, Tilmann</creator><creator>Huebner, Johannes</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-1232-4646</orcidid></search><sort><creationdate>20200205</creationdate><title>Comparison of antibiotic and acyclovir usage before and after the implementation of an on-site FilmArray meningitis/encephalitis panel in an academic tertiary pediatric hospital: a retrospective observational study</title><author>Hagen, Alexandra ; 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However, in children the most common pathogens are viruses that usually do not require and are not covered by the applied anti-infective treatment. Novel multiplex PCR (mPCR) panels provide rapid on-site diagnostic testing for a variety of pathogens. This study compared empiric antibiotic and acyclovir usage before and after the introduction of an on-site FilmArray Meningitis/Encephalitis Panel (FA ME Panel).
We retrospectively compared data for empiric antibiotic and acyclovir usage between pediatric patients with suspected central nervous system (CNS) infection receiving mPCR testing and a matched historical control group. Patients were matched by age and suspected CNS infection. We included all patients for whom empiric antibiotics and/or acyclovir were prescribed.
Each study group consisted of 46 patients with 29 (63.0%) infants and 17 (37.0%) older children. A viral pathogen was diagnosed in 5/46 (10.9%) patients in the control group (all enteroviruses) and in 14/46 (30.4%) patients in the mPCR group (enterovirus n = 9; human herpesvirus 6 (HHV-6) n = 5), (p = 0.038)). Length of Therapy (LoT) and Days of Therapy (DoT) for antibiotics were significantly lower for infants (4.0 vs. 3.0, p = 0.038 and 8.0 vs. 6.0, p = 0.015, respectively). Acyclovir therapy was significantly shorter for both, infants and older children (3.0 vs. 1.0 day, p < 0.001 for both age groups).
The findings of our study suggest that the introduction of a FA ME Panel into clinical routine procedures is associated with a significantly reduced LoT and DoT of empiric anti-infective treatment in children with suspected meningoencephalitis. The largest effect was observed in infants.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>32020860</pmid><doi>10.1186/s12887-020-1944-2</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-1232-4646</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Acyclovir Acyclovir - therapeutic use Adolescent Age Anti-Bacterial Agents - therapeutic use Antibiotics Antimicrobial agents Antimicrobial stewardship Antiviral drugs Bacterial infections Central nervous system Child Child health Child, Preschool Children's hospitals Diagnosis Drug therapy Electronic health records Encephalitis Encephalitis - drug therapy Female FilmArray Herpes viruses Hospitals Hospitals, Pediatric Humans Infant Infants Infection Laboratories Male Medical records Medical research Medical tests Meningitis Meningitis - drug therapy Meningoencephalitis Methods mPCR Novels Observational studies Onsite Pathogenic microorganisms Pathogens Patients Pediatric diseases Pediatric research Pediatrics Polymerase chain reaction Retrospective Studies Streptococcus infections Virology Young Adult |
| title | Comparison of antibiotic and acyclovir usage before and after the implementation of an on-site FilmArray meningitis/encephalitis panel in an academic tertiary pediatric hospital: a retrospective observational study |
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