Program Schedule

1410
Evaluation of the FilmArray for Rapid Identification of Pathogens from Cerebrospinal Fluid (CSF) in Children

Session: Poster Abstract Session: Diagnostic Microbiology: Bacterial Infections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Meningitis is a severe infection that causes significant morbidity and mortality. Rapid etiologic diagnosis is critical to initiation of appropriate therapy. A molecular system to rapidly identify bacteria, viruses, and fungi causing meningitis could improve the medical management of this infection in children. 

Methods: The FilmArray® Meningitis / Encephalitis Panel (FA ME; BioFire Diagnostics, Inc., Salt Lake City, UT) performs automated nucleic acid purification and multiplex PCR to identify 17 bacterial, viral and fungal pathogens directly from CSF. We performed a retrospective study of 120 children < = 18 presenting to our children’s hospital with concern for meningitis. Conventional CSF testing (culture and/or viral testing) was ordered at the discretion of the treating physician. FA studies on archived CSF, using a research use only version of the panel, were performed at the University of Utah. FA ME results were compared to conventional testing. 

Results: The median age of children in the study was 6 months (range 0-237 months). 18 children had positive CSF cultures, of which 11 grew true pathogens. Nine were included on the FA ME panel. FA detected 8/9 cultured panel bacteria, and also detected bacteria in 6 additional specimens (see Table). The median CSF WBC count in children with positive cultures was 391; median WBC for children with positive FA ME testing was 1749. This difference is related to low CSF WBC in samples culture-positive for presumed contaminants. Only 4 children had viruses detected by conventional methods, including PCR of blood or CSF. FA ME detected viruses in 16 samples, including 4 also positive for bacteria. 

Conclusion: The FilmArray ME panel is a sensitive tool for the rapid identification of pathogens from CSF and may identify causative pathogens not detected by conventional testing. Improved detection of pathogens from CSF using FilmArray has the potential to improve treatment and outcomes for children with meningitis. 

Pathogen Identified by Conventional Testing (n) Identified by FilmArray (n)
S. pneumoniae 3 4
S. agalactiae 1 2
N. meningitidis 1 1
H. influenzae 3 4
E. coli 1 3
K. pneumoniae/C. koseri 1/1 0/0
Presumed contaminants (skin flora) 7 0
HSV/HHV6/EBV/CMV/VZV 0/1/1/0/0 1/8/5/0/0
Enterovirus/Parechovirus 2/0 2/1
Caroline Heyrend, PharmD1, Jarrett Killpack, BSc1, Kimberly Hanson, MD, MHS2, Trenda Barney, MT3, E. Kent Korgenski, MS4, Christi Ng, MPH5, Andrew Hemmert, PhD6, Mark a. Poritz, PhD6, Judy Daly, PhD7,8 and Anne J. Blaschke, MD, PhD1, (1)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (2)University of Utah School of Medicine, Salt Lake City, UT, (3)Microbiology, Primary Children's Hospital, Salt Lake City, UT, (4)Department of Pediatrics, Pediatric Clinical Program, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, UT, (5)Intermountain Healthcare, Salt Lake City, UT, (6)BioFire Diagnostics, LLC, Salt Lake City, UT, (7)Microbiology, Primary Children's Medical Center, Salt Lake City, UT, (8)Pathology, University of Utah School of Medicine, Salt Lake City, UT

Disclosures:

C. Heyrend, None

J. Killpack, None

K. Hanson, BioFire Diagnostics, LLC: Collaborator, Co-investigator on NIH grant; BioFire Principal Investigator

T. Barney, None

E. K. Korgenski, None

C. Ng, None

A. Hemmert, BioFire Diagnostics: Employee, Salary

M. A. Poritz, BioFire Diagnostics: Employee, Salary

J. Daly, None

A. J. Blaschke, BioFire Diagnostics LLC: Collaborator and Scientific Advisor, Co-Investigator on NIH grant, BioFire Principal Investigator, Consulting fee and Licensing agreement or royalty

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