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Abstract

The introduction of bacterial polysaccharide-protein conjugate vaccines has led to a significant reduction in the incidence of childhood bacterial meningitis (1,2). Over the last two decades, there has been a rapid increase in the diagnosis of viral meningitis in infants and young children (3,4). This apparent increase appears to be driven by the replacement of traditional culture methods with highly sensitive molecular diagnostic tools such as polymerase chain reaction (PCR) assays (5). The use of multiplex PCR assays, which rapidly identify viral causes of meningitis, could lead to reduction in healthcare costs (e.g. shortened hospital length of stay), improvement in antimicrobial stewardship (e.g. early discontinuation of antibiotics) and reduction in pain (e.g. minimising investigations such as repeat blood cultures/lumbar punctures). However, data from a U.K surveillance study shows that the uptake of PCR assays to detect viral pathogens in the evaluation of meningo-encephalitis is highly variable across National Health Service (NHS) laboratories (6). The indication to test for viruses in CSF varies is dependent on the age of the patient, evidence of pleocytosis, specific clinician request or seasonality. The BioFire FilmArray Meningitis/Encephalitis PCR panel (ME PCR Panel, FilmArray, BioFire Diagnostics, Salt Lake City, UT) can detect 14 common bacteria, viruses and yeast from CSF, requires 0.2mls of CSF and delivers a result within an hour. However, uncertainty exists on how best to integrate the test into the routine diagnostic algorithm, financial cost, concern regarding false positive bacterial results (mainly with Streptococcus pneumoniae and group B Streptococcus) and false negative viral results (mainly with HSV) in children (7). We evaluated the impact of the BioFire FilmArray on the clinical management of children with suspected meningo-encephalitis in two large tertiary paediatric hospitals in England and Ireland.