Evaluation of the FilmArray for Rapid Identification of Pathogens from Cerebrospinal Fluid (CSF) 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)|
|K. pneumoniae/C. koseri||1/1||0/0|
|Presumed contaminants (skin flora)||7||0|
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