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.

Dr. Yogesh Kumar Gupta is currently the Lab Head and Senior Consultant in Microbiology, and the Head of Infection Control at Rukmani Birla Hospital, Jaipur. He completed his MBBS from SMS Medical College, Jaipur, and MD in Microbiology from SP Medical College, Bikaner, along with specialized training in critical care (IDCC) and infection control. His key areas of interest include hospital infection control, antimicrobial stewardship, laboratory quality management, and healthcare accreditation. He is a Principal Assessor for NABH, a Technical Assessor for NABL, and actively contributes to setting infection prevention standards. Dr. Gupta has conducted multiple CMEs on antimicrobial stewardship and surgical prophylaxis, and regularly lectures in microbiology and critical care forums. He has organized three consecutive CME-cum-certificate courses on infection control, accredited by the Rajasthan State Medical Council. He is also the Founder of the Rajasthan State Chapter of the Indian Association of Medical Microbiologists and currently serves as an Executive Member of its national body