■Biofire®FilmArray®脑膜炎/脑炎(ME)PCR面板涵盖14种病毒,细菌,和真菌病原体,并已在全球许多机构实施。上市后的研究表明,敏感性降低和过度利用,强调需要更有针对性的使用。我们研究的目的是描述ME面板的使用情况,并制定基于诊断管理的决策规则。
■成人患者,他们在2016年8月至2021年6月期间在巴塞尔大学医院与ME小组进行了CSF分析,包括在内。人口统计,临床,微生物,从电子健康记录中提取实验室数据。确定了与ME组阳性结果相关的因素,并制定了决策规则,以潜在地优化诊断产量并减少不必要的测试数量。
■1,236名成年患者在观察期间至少接受了一个小组,其中106个小组检测呈阳性(8.6%)。最常见的病原体是水痘带状疱疹病毒(VZV,27%),肺炎链球菌(19%),肠道病毒(16%),单纯疱疹病毒1/2(16%),和人类疱疹病毒6(HHV-6,13%)。发烧,呕吐,头痛,在试验阳性患者中,畏光更常见,脑脊液白细胞和蛋白质浓度显着升高。当模拟基于CSF白细胞和蛋白质浓度的决策规则时,所有患者中只有35%有资格进行ME小组检查,从而将阳性率提高到22.7%。106个阳性ME面板中的10个将被遗漏,仅涉及HHV-6和VZV(6和4例,分别)。由于这些受试者要么严重免疫受损,要么具有带状疱疹的临床特征,因此我们建议通过包括这些标准来扩展测试算法。
■我们机构的ME面板阳性率与之前发布的相似。我们的结果强调了在使用该测定法时,通过基于有限数量的临床和实验室特征实施逐步方法来进行诊断管理干预的必要性。此决策规则可以提高测试结果肯定的预测试概率,提高测试利用的质量,并降低成本。
UNASSIGNED: The Biofire® FilmArray® Meningitis/Encephalitis (ME) PCR panel covers 14 viral, bacterial, and fungal pathogens and has been implemented in many institutions worldwide. Post-marketing studies indicate a reduced sensitivity and overutilization underscoring the need for a more targeted usage. The aim of our study is to describe the utilization of the ME panel and to develop a diagnostic-stewardship based decision rule.
UNASSIGNED: Adult patients, who underwent CSF analysis with the ME panel between August 2016 and June 2021 at the University Hospital Basel, were included. Demographic, clinical, microbiological, and laboratory data were extracted from the electronic health record. Factors associated with a positive ME panel result were identified, and a decision rule was developed to potentially optimize the diagnostic yield and reduce the number of unnecessary tests.
UNASSIGNED: 1,236 adult patients received at least one panel in the observed period, of whom 106 panels tested positive (8.6%). The most frequently observed pathogens were Varicella Zoster Virus (VZV, 27%), Streptococcus pneumoniae (19%), Enterovirus (16%), Herpes simplex Virus 1/2 (16%), and Human Herpesvirus 6 (HHV-6, 13%). Fever, vomiting, headache, and photophobia were more frequently present in test positive patients as were significantly higher CSF leukocytes and protein concentrations. When simulating a decision rule based on CSF leukocytes and protein concentration, only 35% of all patients would have qualified for a ME panel tests, thereby increasing the positivity rate to 22.7%. 10 of 106 positive ME panels would have been missed, only involving HHV-6 and VZV (6 and 4 cases, respectively). As these subjects were either severely immunocompromised or had clinical features of shingles we propose extending the testing algorithm by including those criteria.
UNASSIGNED: The ME panel positivity rate at our institution was similar as previously published. Our results highlight the need for diagnostic-stewardship interventions when utilizing this assay by implementing a stepwise approach based on a limited number of clinical and laboratory features. This decision rule may improve the pretest probability of a positive test result, increase the quality of test utilization, and reduce costs.