Background: Delayed etiological diagnosis in suspected meningitis and encephalitis often necessitates prolonged empirical broad-spectrum antimicrobial therapy. Rapid syndromic molecular diagnostics, such as the BioFire® Meningitis/Encephalitis (ME) Panel, have the potential to function as a clinical intervention by enabling earlier pathogen identification and antimicrobial optimization within routine clinical practice.

Objectives: To assess the clinical impact of BioFire® ME Panel implementation on antimicrobial days of therapy (DOT), time to optimal therapy, and antimicrobial stewardship outcomes in patients with suspected central nervous system (CNS) infections.

Methods: We conducted a retrospective, before–after interventional clinical study at a tertiary-care center, comparing patients managed prior to BioFire® ME Panel implementation (Pre-BioFire group, n=80) with those managed after implementation (Post-BioFire group, n=80). Baseline demographic and clinical characteristics were comparable between groups. The primary outcome was total antimicrobial DOT. Secondary outcomes included time to optimal therapy, antimicrobial de-escalation or discontinuation, length of hospital stay, and in-hospital mortality.

Results: Implementation of the BioFire® ME Panel was associated with significant reductions in median antimicrobial DOT, including vancomycin (6 vs 4 days; 33.3%; p<0.05), third-generation cephalosporins (10 vs 4 days; 60.0%; p<0.05), carbapenems (6 vs 4 days; 33.3%; p<0.05), and acyclovir (6 vs 2 days; 66.7%; p<0.01). Overall antimicrobial exposure was reduced by 50% (median DOT 8 vs 4 days; p<0.01). Median time to optimal therapy decreased from 96 hours to 24 hours (p<0.05), facilitating earlier targeted therapy and stewardship-guided de-escalation.

Conclusions: In this real-world clinical evaluation, rapid syndromic molecular testing using the BioFire® ME Panel functioned as an effective diagnostic intervention, significantly reducing antimicrobial exposure and accelerating time to optimal therapy in suspected CNS infections. Integration of rapid diagnostics with active antimicrobial stewardship represents a clinically impactful strategy to optimize antimicrobial use.

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