Implementation of the eazyplex(®) CSF direct panel assay for rapid laboratory diagnosis of bacterial meningitis: 32-month experience at a tertiary care university hospital

We aimed to report a 32-month laboratory experience with the eazyplex® CSF direct panel assay for the rapid diagnosis\r\nof meningitis due to six most common bacterial species (Escherichia coli, Haemophilus influenzae, Listeria\r\nmonocytogenes, Neisseria meningitidis, Streptococcus agalactiae, and Streptococcus pneumoniae). We included all\r\ncerebrospinal fluid (CSF) samples from patients admitted with a clinical suspicion of meningitis/encephalitis between\r\nMay 2016 and December 2018 at our hospital. In addition to the eazyplex® assay, both Gram stain microscopy and\r\nculture were performed, and results were confirmed with 16S rRNA PCR/sequencing. Patients’ demographics and\r\nrelevant clinical information were collected. Of 135 studied patients, 44 (32.6%) had a microbiologically documented\r\ndiagnosis of meningitis. Overall, we identified 21 S. pneumoniae, 10 N. meningitidis, 6 L. monocytogenes, 3 E. coli, 2\r\nStreptococcus pyogenes, 1 S. agalactiae, and 1 Citrobacter koseri as aetiological agents. The eazyplex® assay allowed\r\nidentification in 40 (90.9%) cases, with four not identified cases due to microorganisms not included in the panel at the\r\ntime of testing. Thirty-two (72.7%) cases had positive culture results, whereas 28 (63.6%) cases had positive Gram stain\r\nresults. Notably, combining Gram stain and eazyplex® assay allowed identification in 100% of cases. After notification\r\nof rapid results, physicians modified the empiric antibiotic therapy, which became appropriate in three patients (all with\r\nL. monocytogenes meningitis). The eazyplex® CSF panel assay worked better than culture in detecting the most common\r\nagents of bacterial meningitis and accelerated the diagnosis leading to timely initiation or continuation of appropriate\r\nantibiotic therapy.