Department of Virology, St Antoine - Tenon - Trousseau University Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France.
Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
Microbiol Spectr. 2022 Apr 27;10(2):e0277421. doi: 10.1128/spectrum.02774-21. Epub 2022 Apr 11.
Meningitis/encephalitis (ME) syndromic diagnostic assays can be applied for the rapid one-step detection of the most common pathogens in cerebrospinal fluid (CSF). However, the comprehensive performance of multiplex assays is still under evaluation. In our multisite university hospital of eastern Paris, France, ME syndromic testing has been gradually implemented since 2017 for patients with neurological symptoms presenting to an adult or pediatric emergency unit. We analyzed the results from the BioFire FilmArray ME panel versus standard routine bacteriology and virology techniques, together with CSF cytology and clinical data, over a 2.5-year period to compare the diagnostic accuracy of the FilmArray ME panel to that of the reference methods. In total, 1,744 CSF samples from 1,334 pediatric and 336 adult patients were analyzed. False-positive (mostly bacterial) and false-negative (mostly viral) cases were deciphered with the help of clinical data. The performance of the FilmArray ME panel in our study was better for bacterial detection (specificity >99%, sensitivity 100%) than viral detection (specificity >99%, sensitivity 75% for herpes simplex virus 1 [HSV-1] and 89% for enterovirus), our study being one of the largest, to date, concerning enteroviruses. The use of a threshold of 10 leukocytes/mm considerably increased the positive agreement between the results of the FilmArray ME panel and the clinical features, especially for bacterial pathogens, for which agreement increased from 58% to 87%, avoiding two-thirds of inappropriate testing. Based on this analysis, we propose an algorithm for the use of both syndromic and specific assays for the optimal management of suspected meningitis/encephalitis in adult and pediatric patients. Based on our comparative analysis of performances of the diagnostic assays, we propose an algorithm for the use of both syndromic and specific assays, for an optimal care of the meningitis/encephalitis threat in adult and pediatric patients.
脑膜炎/脑炎（ME）综合征诊断检测可用于快速一步检测脑脊液（CSF）中最常见的病原体。然而，多重检测的综合性能仍在评估中。在法国巴黎东部的一家多地点大学医院，我们自 2017 年以来逐步对出现神经症状的成年或儿科急诊患者进行 ME 综合征检测。我们分析了在 2.5 年期间，与标准常规细菌学和病毒学技术以及 CSF 细胞学和临床数据相比，BioFire FilmArray ME 检测板的结果，以比较 FilmArray ME 检测板的诊断准确性与参考方法的诊断准确性。总共分析了来自 1334 例儿科和 336 例成年患者的 1744 例 CSF 样本。借助临床数据，解析了假阳性（主要是细菌）和假阴性（主要是病毒）病例。在我们的研究中，FilmArray ME 检测板在细菌检测方面的性能优于病毒检测（特异性>99%，灵敏度 100%用于单纯疱疹病毒 1[HSV-1]，89%用于肠道病毒），这是迄今为止关于肠道病毒的最大研究之一。使用 10 个白细胞/mm 的阈值可大大提高 FilmArray ME 检测板的结果与临床特征之间的阳性一致性，特别是对于细菌病原体，其一致性从 58%增加到 87%，避免了三分之二的不适当检测。基于此分析，我们提出了一种在成年和儿科患者中疑似脑膜炎/脑炎的最佳管理中使用综合征和特定检测的算法。基于我们对诊断检测性能的比较分析，我们提出了一种在成年和儿科患者的脑膜炎/脑炎威胁中使用综合征和特定检测的算法。
