90
days of age with suspected aseptic meningitis. NeoNotes
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Thomas M. Berger MD, Guest Editor
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CSF Enterovirus PCR
King RL, Lorch SA, Cohen DM, et al. Routine Cerebrospinal Fluid Enterovirus Polymerase Chain Reaction Testing Reduces Hospitalization and Antibiotic Use for Infants 90 Days of Age or Younger. PEDIATRICS (September 2007); 120: 489-496.
OBJECTIVE. The
goal was to evaluate the impact of cerebrospinal fluid enterovirus
polymerase chain reaction testing on the length of hospitalization
and the duration of antibiotic use for infants 90
days of age with suspected aseptic meningitis.
METHODS. This
retrospective cohort study was conducted at an urban, tertiary-care
children's hospital. Data were collected for 478 patients 90
days of age for whom cerebrospinal fluid enterovirus polymerase chain
reaction testing was performed during the enteroviral seasons of 2000
to 2006. The length of hospitalization and the duration of antibiotic
use were assessed.
RESULTS. Cerebrospinal fluid enterovirus polymerase chain reaction test results were positive for 154 patients (34.8%). The mean length of stay was 3.65 days. The median polymerase chain reaction turnaround time was 23 hours. In multivariate analysis, having a positive cerebrospinal fluid enterovirus polymerase chain reaction result was associated with a 1.54-day decrease in the length of stay and a 33.7% shorter duration of antibiotic use. When patients were stratified according to the presence or absence of pleocytosis, both groups demonstrated significant reductions in the length of stay with positive cerebrospinal fluid enterovirus polymerase chain reaction results (1.32 and 1.38 days, respectively). Furthermore, increasing the polymerase chain reaction turnaround time by 24 hours increased the length of stay by 13.6% for patients with positive cerebrospinal fluid enterovirus polymerase chain reaction results.
CONCLUSIONS. Having positive cerebrospinal fluid enterovirus polymerase chain reaction results decreases the length of hospitalization and the duration of antibiotic use for young infants. These results support the routine use of this test during periods of peak enterovirus prevalence.
Comments. A positive Enterovirus PCR confirms the diagnosis of viral meningitis, and can decrease unnecessary antibiotic treatment and length of stay in these infants. These advantages are maximized if the turn-around-time for this test can be reduced to < 24 hours. Hospitals should consider whether it would be cost-effective to do these tests in-house rather than sending samples to outside laboratories for testing. ABK.
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