273. Effects of a rapid meningitis/encephalitis panel on antimicrobial use and clinical outcomes in children.
Session: Poster Abstract Session: Pediatric Antimicrobial and Diagnostic Stewardship
Thursday, October 4, 2018
Room: S Poster Hall
Background:

Rapid molecular diagnostic assays are increasingly used to guide effective antimicrobial therapy. Data on their effectiveness to decrease antimicrobial use has been limited and varied. We aimed to assess the impact of the implementation of the FilmArray Meningitis Encephalitis Panel (MEP) on antimicrobial (AM) use and outcomes in children.

Methods:

In an observational retrospective study performed at Atlantic Health System (NJ), we reviewed medical records of patients <21 years of age evaluated for meningitis/encephalitis who received empiric AM therapy between 01/01/2015 and 09/30/18. Oncology and Neurosurgery patients were excluded. FilmArray MEP (BioFire Diagnostics, Salt Lake City, UT) was incorporated 11/01/16. The primary outcome was to evaluate duration of empiric AM therapy measured as days of therapy (DOT). Secondary outcomes included length of stay (LOS), all-cause mortality and 30-day readmission rates.

Results:

Ninety-nine patients with negative CSF, blood, and urine cultures who received empiric AM therapy were included in the preliminary analysis. Patient characteristics are depicted in Table 1. The median duration of antibiotic (AB) therapy prior to the implementation of the MEP was 4 DOT (IQR 6) versus 2 DOT (IQR 4). During the pre-implementation era, the median DOT for individual AB was 3 (IQR 2) for 3rd-generation cephalosporins (3GCs) (n 23), 3 (IQR 1) for ampicillin (AMP) (n 19) and 2 (IQR 1) for vancomycin (VAN) (n 8). Median DOT when MEP was performed was 2 (IQR 1) for 3GCs (n 28), 2 (IQR 1) for AMP (n 18) and 2 (IQR 1) for VAN (n 6). Few patients received acyclovir (ACY), with a median DOT of 4 (IQR 0) and 2 (IQR 2) before (n 4) and after MEP (n 8), respectively. Secondary outcomes are shown in Table 2.

Table 1. Patient Characteristics

Pre-MEP

(N:49)

MEP

(N:50)

Age in years, mean (range)

3.8 (0-18)

3.5 (0-17)

Male:Female

1:1

2:1

NICU/PICU care, n (%)

11 (23)

16 (32)

CSF WBC, median (IQR)

2 (14) cells/mm3

3 (10) cells/mm3

Table 2.

Pre-MEP

(N:49)

MEP

(N:50)

LOS, median (IQR)

4 (3)

3 (2)

All-cause 30 day-readmission

4

0

All-cause mortality

0

0

Conclusion: In our experience, the implementation of the MEP decreased AB use and LOS. This impact was noted mainly on 3GCS and AMP. Few patients received VAN and ACY to assess the effect on these agents.

Danielle McDonald, PharmD1, Christina Gagliardo, MD2,3 and M. Cecilia Di Pentima, MD, MPH2,3, (1)Pharmacy, Atlantic Health System, Morristown, NJ, (2)Pediatrics, Atlantic Health System, Morristown, NJ, (3)Pediatrics, Thomas Jefferson University, Philadelphia, PA

Disclosures:

D. McDonald, None

C. Gagliardo, None

M. C. Di Pentima, None

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