Meningitis In Canada: Rapid Diagnostics and Antimicrobial Stewardship Address The Risk Of Life-Long Complications

The World Health Organization (WHO) set up an ambitious roadmap towards having a world free of meningitis by 2030. This plan, aiming at the reduction of meningitis and reduction of its adverse events, relied on five key interconnected pillars:

Prevention and epidemic control
Diagnosis and treatment
Disease surveillance
Care and support
Advocacy and engagement

While the incidence of meningitis in Canada is low, the consequences resulting from it can last a lifetime and are a major cause of disability, especially in children. However, for active cases that are very serious and require long-term hospital stays and multiple rounds of antimicrobials, the likelihood of death, amputation and life-long disability remains unchanged. In fact, without timely treatment, almost all children with meningococcal disease will die or suffer lifelong damages¹. Understandably, diagnosis plays a critical role in improving patient outcomes while also addressing concerns around antimicrobial resistance associated with inadequate use of antibiotics.

Saving lives through advanced diagnostics technology

As a result of the Covid-19 pandemic, many regional centers in Canada have been equipped with advanced diagnostics technology, such as BioFire, that enables them to address the challenges associated with timely detection of meningitis. Detecting Meningitis and its etiology in less than 1 hour is truly a game changer in the fight against Meningitis for these sites that rely on reference labs for results. In fact, the BioFire Meningitis/Encephalitis (ME) panel offers a novel and unique solution for the detection of 14 pathogens associated with bacterial, viral and fungal meningitis with one single CSF sample, reducing care discrepancies between regional and urban hospitals.

Since meningitis patient outcomes are strongly influenced by the time of detection and initiation of the ideal therapy^2,3, being able to detect and identify meningitis rapidly and with confidence is clinically meaningful for proper patient management, therapy and antimicrobial stewardship. PCR is the only technology able to combine timely results with sensitivity, thus mitigating the limitations of traditional culture, the standard of care for fungal and bacterial pathogen identification. Viral infection is largely non-specific and several tests are required to cover the spectrum of potential pathogens, taking precious time for these patients.

Studies show BioFire’s impact on reducing unnecessary antibiotic treatment

In fact, studies^[4] involving BioFire ME panel have shown reduction in unnecessary treatment, broad antibiotic use and antiviral prescription in both pediatric and adult patients by up to a day. Therapy improvement has also been demonstrated with reduced time for therapy narrowing, decreasing or even eliminating the intake of acyclovir due to the rapid TAT of the BioFire ME panel – an important milestone for lowering the risk of acute kidney injury associated with empiric acyclovir usage[5]. In a pre/post study performed by Nabower et al., 21.7% fewer patients were treated with acyclovir when tested on the BioFire ME Panel. Additionally, 70.4% of patients never received a dose of acyclovir compared to 48.3% in the control group, likely resulting from the rapid TAT of the BioFire ME Panel.

How can antimicrobial stewardship programs help?

When combined with an antimicrobial stewardship software, such as Lumed’s APSS +, BioFire ME becomes a powerful solution for improving Meningitis patient outcomes through rapid diagnostic and optimized therapeutic pathway focused on the right medication, right dosage and right timing through timely follow-up. APSS+ also determines the suboptimal dosage regimens in specific populations, such as renal failure, dialysis, cystic fibrosis, underweight, or morbidly obese patients. It can target significant drug interactions and spectrum redundancies with antimicrobials while suggesting alternatives. This way, doctors and pharmacists can prevent inefficient prescriptions and can be given alternatives to avoid meningitis from escalating to sepsis and/or death while also mitigating the risks associated with antimicrobial resistance.

Source:

^[1]https://caringforkids.cps.ca/handouts/health-conditions-and-treatments/meningococcal_diseases

^[2] Auburtin M, Wolff M, Charpentier J, et al. Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: The PNEUMOREA prospective multicenter study. Crit Care Med 2006;34(11):2758-65.

^[3] Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39(9):1267-84.

[4] O’Brien MP, Francis JR, Marr IM, Baird RW (2018) Impact of Cerebrospinal Fluid Multiplex Assay on Diagnosis and Outcomes of Central Nervous System Infections in Children: A Before and After Cohort Study. The Pediatric infectious disease journal 37:868–871

López-Amor L, Escudero D, Fernández J, et al (2019) Diagnóstico de meningitis/encefalitis en UCI con sistema de PCR múltiple.?` Es tiempo de cambio? Revista Española de Quimioterapia 32:246

[5] Nabower AM, Miller S, Biewen B, Lyden E, Goodrich N, Miller A, Gollehon N, Skar G, Snowden J (2019) Association of the FilmArray Meningitis/Encephalitis Panel With Clinical Management. Hospital pediatrics Oct;9(10):763-769

Evans M. et al: Impact of the implementation of a rapid meningitis/encephalitis multiplex polymerase chain reaction panel on IV acyclovir duration: multicenter, retrospective cohort of adult and pediatric patients; Diagnostic Microbiology and Infectious Disease, 6 November 2019; 114935

Meningitis In Canada: Rapid Diagnostics and Antimicrobial Stewardship Address The Risk Of Life-Long Complications

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