Impact of Cerebrospinal Fluid Multiplex Assay on Diagnosis and Outcomes of Central Nervous System Infections in Children: A Before and After Cohort Study

Background: This study evaluated the performance of cerebrospinal fluid multiplex assay in the diagnosis of pediatric central nervous system (CNS) infection, and assessed for the effect on clinical management. Methods: A 15-month prospective cohort of pediatric patients with confirmed CNS infection was compared with a 15-month retrospective cohort from the Top End region of the Northern Territory, Australia. The study characterized all the CNS infections over the 30-month period and compared the time to organism identification and antibiotic management before and after the introduction of the multiplex assay. Results: Thirty-six cases of pediatric CNS infection were diagnosed before the introduction of the multiplex assay, and 29 afterwards. Multiplex assay was performed on 26/29 (90%) of the cerebrospinal fluid isolates from children with confirmed CNS infections in the prospective cohort. Enterovirus was the most common causative organism identified in 14 children, followed by human parechovirus in 4 children. The multiplex assay performed with 93.8% sensitivity and 90.0% specificity when compared with microbiologic culture or reference laboratory results. The median time to organism identification reduced from 6.0 to 2.0 days (P value <0.001), the median duration of antibiotic therapy from 3.0 to 2.0 days (P value <0.001) and median hospitalization reduced from 5.0 to 3.0 days (P value 0.016) after introduction of the multiplex assay. Conclusions: The multiplex assay is a useful adjunct diagnostic tool enabling prompt organism identification and reducing antibiotic treatment and hospitalization duration. The assay would be of most value to hospitals that do not have access to an onsite molecular laboratory.