334. Implementation of FilmArray Meningitis/Encephalitis Panel at a Tertiary Medical Center

Background A rapid and accurate meningitis/encephalitis diagnostic test can have a significant clinical impact and improve utilization of antimicrobial agents. The FilmArray Meningitis/Encephalitis Panel, a multiplex PCR meningitis/encephalitis panel (MEP) (bioMérieux, Marcy l’Etoile, France) requires only 200 μL of cerebral spinal fluid (CSF) and takes less than 1 hour to simultaneously detect 14 pathogens. The objective of the study was to evaluate the outcome of MEP at our medical center. Methods Retrospective review of 433 patients with an MEP performed from April 2017 to March 2018. Demographics characteristics, signs and symptoms, immune status, laboratory and radiology results and antibiotic use were collected. Results Twenty-nine unique patients with positive CSF samples (Table 1). The mean age was 41 years old with 55% female predominance. The most common presentations were headache (65%) and fever (38%). Patients with H. influenzae and Group B Strepmeningitis had positive blood culture (CX) but negative CSF CX. Both the CSF and the blood CX were negative for the patient with L. monocytogenes. MEP identified six Cryptococcus sp. with concurrent positive CSF CX and Cryptococcus antigen. However, three patients had CSF Cryptococcus CX positive but MEP was negative. Only one of six patients with HHV-6 received treatment. Table 1. Pathogen Identified With FilmArray ME Panel Pathogen Detected # Positive MEP Human herpes virus-6 (HHV6)* 6 Cryptococcus gattii/neoformans* 5 Enterovirus 5 Human simplex virus (HSV)-2 4 Cytomegalovirus 3 Varicella zoster 2 HSV-1 1 Streptococcus agalactiae 1 Haemophilus influenzae 1 Escherichia coli K1 1 Listeria Monocytogenes 1 Streptococcus pneumoniae 0 Human parechovirus 0 Neisseria meningitis 0 *One patient with Cryptococcus and HHV-6 co-infection Conclusion The FilmArray MEP can rapidly diagnose ME infections, help to target therapy and allow for discontinuation of unnecessary empiric agents. Paired cultures are needed for drug susceptibility tests and in patients suspected of Cryptococcusmeningitis due to false negative MEP results. Majority of patients with HHV-6 did not receive treatment and attributed the positive result due to possibly chromosomal integration of HHV6. Multiple Pathogen Detected # of Patients Epstein–Barr Virus + HHV 6 1 Cryptococcus + HHV 6 1 Disclosures R. Hasbun, Biofire: Speaker’s Bureau, Speaker honorarium. Biomeriaux: Consultant, Consulting fee.