Slenker, Amy, MD

Stempel, Max

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationEvaluation of the Implementation of RapidCerebral Spinal Fluid Diagnostic Test forMeningitis and Encephalitis at a Large AcademicInstitutionMax StempelMax.Stempel@lvhn.orgAmy Slenker MDLehigh Valley Health Network, amy_k.slenker@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtStempel, M. Slenker, A. (2019, August). Evaluation of the Implementation of Rapid Cerebral Spinal Fluid Diagnostic Test for Meningitisand Encephalitis at a Large Academic Institution. poster Presented at: LVHN Research Scholar Program Poster Session, Lehigh ValleyHealth Network, Allentown, PA.Lehigh Valley Health Network, Allentown, Pennsylvania• Meningitis and encephalitis are central nervous system (CNS) infectious diseases associated with significant morbidity and mortality in adult populations.• Traditional approaches of culture and pathogen-specific polymerase chain reaction (PCR) tests are limited by slow turnaround time and low diagnostic yield.• The FilmArray Meningitis and Encephalitis (M/E) panel is a multiplex PCR test targeting a combination of 14 viruses, bacteria, and yeasts. • The M/E panel was first introduced at LVHN in February, 2016.• Time to diagnosis decreased in the post-intervention group for all pathogens included on the M/E panel.• The post-intervention group had a reduced time from antibiotic initiation to discontinuation (70.0 h vs 81.7 h) and reduced antibiotic days of therapy (2.9 d vs 3.4 d) for negative CSF results• The post-intervention group had an overall decreased mean time to targeted therapy (27.7 h vs. 32.9 h) and reduced mean time to diagnosis (21.2 h vs. 39.1 h) for positive CSF results.• The post-intervention group had a reduced average number of CSF tests (3.6 vs. 4.7).• Notably, this translated into an increase in the average patient charge: $1,339.79 vs. $1,458.45, but a decrease in the average supply cost ($434.26 vs $314.29) in the post-intervention group.This study aims to determine how the M/E panel affects clinical outcomes including: time to diagnosis, appropriate antibiotic deescalation, days of therapy, and mortality.BackgroundObjectivesResults Results/DiscussionConclusions/Recommendations Evaluation of the Implementation of Rapid Cerebral Spinal Fluid Diagnostic Test for Meningitis and Encephalitis at a Large Academic InstitutionMax Stempel, Amy Slenker, MDMethodsRetrospective analysis of patients with CSF culture from 2/23/2015 to 2/22/2016 (Pre-Intervention) and M/E panel and CSF culture from 2/23/2016 to 2/22/2017 (Post-Intervention). Review EMR for: demographics, length of stay, type of CSF studies, CSF collection date and time, CSF result date and time, antibiotics administered, antibiotic initiation and discontinuation date and time. Perform descriptive statistics to compare the pre and post-intervention groups regarding: time to diagnosis, time to antibiotic deescalation, days of therapy, mortality.Pre-group (N=97)Post-group (N=74)Mean Time toAntibiotic Deescalation (SD)81.7 (85.5) 70.0 (93.2)Mean Days of Therapy (SD)3.4 (3.6) 2.9 (3.9)Mean # CSF Tests Ordered (Range)4.7 (1-13) 3.8 (2-13)Mean Length of Stay Days (Range)7.9 (1-33) 9.5 (2-57)Key: ICU, Intensive Care Unit; CSF, cerebrospinal fluid.Table 2. Positive CSF Test ResultsPre-group (N=23)Post-group (N=20)Mean Time to Targeted Antibiotic (SD)32.9 (25.9) 27.7 (32.2)Mean Time to Diagnosis in Hours (SD)39.1 (40.3) 21.2 (39.0)Mean # CSF Tests Ordered (Range)5.0 (2-10) 2.9 (2-5)Mean Length of Stay Days (Range)7.6 (1-28) 9.0 (3-52)• The implementation of the M/E panel has resulted in improved time to diagnosis, time to antibiotic deescalation for negative CSF tests and time to targeted antibiotic therapy for positive CSF test results• Future research using a larger sample size is needed to determine if there is a change in outcomes data including: length of stay, ICU stay, and mortality.References/Acknowledgments 1. Messacar K, Breazeale G, Robinson CC et al. Potential clinical impact of the film array meningitis encephalitis panel in children with suspected central nervous system infections. Diagnostic Microbiology & Infectious Disease, 2016-09-01, Volume 86, Issue 1, Pages 118-120 2. Leber AL, Everhart K, Balada-Llasat J-M et al. Multicenter evaluation of the BioFire FilmArray meningitis/encephalitis panel for the detection of bacteria, viruses, and yeast in cerebrospinal fluid specimens. J Clin Microbiol 2016; 54:2251–2261.3. Kupila L, Vuorinen T, Vainionpää R et al. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006; 66(1):75.4. BioFire Diagnostics. 2015. FilmArray Meningitis/Encephalitis (ME) Panel instruction booklet RF-Y-ASY-0118. BioFireDiagnostics, Salt Lake City, UT.Special thanks to Health Network Laboratories (HNL) for their assistance with data and cost/charge information. Table 1. Negative CSF Test Results56.4513.3569.6925.03 24.3060.3415.3835.6385.2434.6510.7742.478.575.6310.1886.18-20020406080100120Pre-InterventionPost-InterventionTime from antibiotic initiation to targeted therapy (hr) Figure 2. Time from Antibiotic Initiation to Targeted Therapy for Positive CSF Test ResultsPathogen*M/EP does not include Lyme disease nor other bacterial etiologies**Standard error bars and data points included. 29.9534.8322.26 28.01 21.2452.66190.6773.208.49 4.37 9.99 5.47 12.24 7.58170.9778.48-50050100150200250Pre-InterventionPost-InterventionFigure 3. Time to Diagnosis for Positive CSF Test ResultsPathogenTime to Diagnosis **Standard error bars and data points included. 

Evaluation of the Implementation of Rapid Cerebral Spinal Fluid Diagnostic Test for Meningitis and Encephalitis at a Large Academic Institution

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Evaluation of the Implementation of Rapid Cerebral Spinal Fluid Diagnostic Test for Meningitis and Encephalitis at a Large Academic Institution

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