How do we reduce acyclovir overuse? Impact of FilmArray meningitis/encephalitis panel tests for pediatric patients.

BACKGROUND: Few Japanese hospitals can perform in-house cerebrospinal fluid (CSF) polymerase chain reaction (PCR) to screen for herpes simplex virus, leading to patients being administered acyclovir (ACV) for several days. The FilmArray Meningitis/Encephalitis Panel (ME Panel) is a multiplex PCR test that can identify 14 major pathogens within 1 h. We aimed to investigate the efficacy of the ME Panel in children admitted with central nervous system infections in Japan. METHODS: We conducted a single-center, quasi-experimental study. The ME panel was introduced in April 2020. We outsourced the CSF samples to a laboratory during the pre-intervention period (April 2016 to March 2020) and performed the ME panel at our hospital during the post-intervention period (April 2020 to December 2021). Duration and dose of ACV and antibiotic use, length of stay (LOS) in the pediatric intensive care unit (PICU), and total LOS after testing were compared using the Mann-Whitney U test. RESULTS: The number of cases in the pre- and post-intervention periods was 67 and 22 cases, respectively. The median duration of ACV decreased significantly from 6 days to 0 day (p < 0.001), and the median dose of ACV use decreased significantly from 14 vials to 0 vial (p < 0.001). No significant differences were noted in the total duration and dose of antibiotic use, LOS in PICU, and the total LOS after testing. CONCLUSION: The introduction of ME panel may contribute to appropriate ACV use; however, there was no significant change in the duration and dose of antibiotic use or LOS.

Case of infant invasive Streptococcus intermedius infection suggesting the need for anaerobic cultures.

We report the case of an immunocompetent 6-month-old boy with a lung abscess and empyema caused by Streptococcus intermedius detected only from anaerobic cultures. Invasive S. intermedius infection in infants is rare. S. intermedius has been infrequently reported as a causative microorganism of lung abscess and empyema as most of the S. intermedius infections in children have been head and neck infections. While anaerobic cultures are often not performed for infant patients, we suggest the need for these cultures, including blood cultures, especially in cases of pediatric empyema, brain abscess, and liver abscess, which can be caused by S. intermedius.