Implementation and Effectiveness of a Rapid Cerebrospinal Fluid Diagnostics Program for Children with Suspected Central Nervous System Infection

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PROJECT SUMMARY/ ABSTRACT Central nervous system (CNS) infections, including meningitis, encephalitis, and myelitis cause significant long-term morbidity, mortality and health care costs, with an increased incidence in children. Rapid identification of an infectious agent in the cerebrospinal fluid (CSF) is essential to guiding the targeted use of effective antimicrobials in children with suspected CNS infection. Currently utilized diagnostic techniques are low-yield, slow, and expensive leading to widespread use of unnecessary empiric antimicrobial therapies and increased health care costs. Newly developed multiplex PCR panels allow for rapid identification of the most common organisms to cause CNS infections within one hour. However, optimal implementation strategies to translate these more rapid test results into more rapid, appropriate clinical action are unknown. This project seeks to optimize implementation of new rapid molecular CSF diagnostic technology in a tertiary care children’s hospital in conjunction with real-time antimicrobial stewardship decision support using RE-AIM methodology for implementation and evaluation. The research detailed in this proposal meets the critical unmet need for clinical outcomes and cost-effectiveness data for new rapid diagnostic technologies. This research aims to develop reproducible and sustainable strategies for implementing rapid diagnostics to optimally impact the clinical care of children through the following specific aims: (1) To optimize a reproducible implementation strategy for rapid cerebrospinal fluid diagnostics in children with suspected central nervous system infection, (2)To measure the impact of a rapid cerebrospinal fluid diagnostics program on the clinical care and health care costs of children with suspected central nervous system infection. This project is the culmination of the candidate’s interest and experience in CNS infections and rapid molecular diagnostic technologies. The overall objective of this career development award is to develop the candidate into an independent principal investigator in clinical research with expertise in the implementation and evaluation of infectious disease diagnostics to facilitate timely and efficient clinical care of children. Through experiential mentored research training and didactic coursework in a doctoral clinical sciences program, essential skills in clinical research, implementation and dissemination science, clinical outcomes, and cost-effectiveness analysis will be developed. The candidate has assembled a multidisciplinary team of mentors and advisors with extensive clinical research experience and topical expertise in the above realms to ensure his success in achieving the stated specific aims and career goals.