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Observational Study
. 2020 Apr 16;20(1):166.
doi: 10.1186/s12887-020-02066-0.

Impact of rapid enterovirus polymerase chain reaction testing on management of febrile young infants < 90 days of age with aseptic meningitis

Paolo Paioni  1 , Florence Barbey  2 , Christa Relly  2 , Patrick Meyer Sauteur  2 , Christoph Berger  2
Affiliations
Observational Study

Impact of rapid enterovirus polymerase chain reaction testing on management of febrile young infants < 90 days of age with aseptic meningitis

Paolo Paioni et al. BMC Pediatr. .

Abstract

Background: Diagnostic evaluation of febrile young infants is challenging. Empirical antimicrobial treatment is therefore common practice in this setting despite high percentage of causative viral infections. The objective of this study was to investigate the impact of rapid enterovirus cerebrospinal fluid polymerase chain reaction (CSF EV PCR) test on hospital length of stay (LOS) and antimicrobial treatment duration in young febrile infants.

Methods: Retrospective observational study comparing duration of antimicrobial treatment and hospital LOS before (May 1, 2014 - May 30, 2015, untested group) and after (June 1, 2015 - June 30, 2017, tested group) the introduction of rapid CSF EV PCR testing in infants < 90 days of age presenting with fever and CSF pleocytosis at the University Children's Hospital Zurich. Additionally, the same variables were compared after test introduction between CSF EV PCR positive and negative children.

Results: One hundred twenty-eight children were enrolled in the study, 58 before and 70 after the introduction of rapid CSF EV PCR testing. Duration of antimicrobial treatment was significantly shortened in EV positive (n = 42) compared to both EV negative (n = 28) (median 18 h and 48 h, respectively, p < 0.001) and untested patients (n = 58) (median 18 h and 48 h, respectively, p < 0.001), and also in tested compared to untested group patients (median 36 vs 48 h, p < 0.001). Hospital LOS was significantly shortened in EV positive compared to EV negative patients (median 3 days and 4 days respectively, p = 0.013), while an overall reduction was not observed between tested and untested group patients.

Conclusions: In this study we demonstrate that antimicrobial treatment duration could be significantly shortened in neonates and young infants < 90 days of age with aseptic meningitis after the introduction of a rapid CSF EV PCR test compared to untested patients before test introduction.

Keywords: Antibiotic treatment; Children; Fever; Pleocytosis; Sepsis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study profile. Recruitment and flow of patients in untested group (left) and tested group (right). 1Pleocytosis defined as the presence of ≥5 white blood cells per μl in CSF. Abbreviations: EV, enterovirus; CSF, cerebrospinal fluid; PCR, polymerase chain reaction; UTI, urinary tract infection; d, days
Fig. 2
Fig. 2
Median duration of antimicrobial treatment (a) and hospital LOS (b). Comparison of duration of antimicrobial treatment (a) and hospital LOS (b) between CSF EV CSF PCR positive, negative and untested group patients using Kruskal-Wallis test. The number in the bars indicates the median value. Abbreviations: LOS, length of stay; EV, enterovirus; CSF, cerebrospinal fluid; PCR, polymerase chain reaction; hrs, hours; d, days
Fig. 3
Fig. 3
Comparison of duration of antimicrobial treatment (a) and hospital LOS (b) between tested and untested group patients. Comparison of medians between tested group (i.e. CSF EV CSF positive and negative patients) and untested group patients using the Mann-Whitney U test. The number in the bars indicates the median value. Abbreviations: LOS, length of stay; EV, enterovirus; CSF, cerebrospinal fluid; PCR, polymerase chain reaction; hrs, hours; d, days
See this image and copyright information in PMC

References

    1. de Jong EP, van den Beuken MGA, van Elzakker EPM, Wolthers KC, Sprij AJ, Lopriore E, et al. Epidemiology of Sepsis-like illness in young infants: major role of Enterovirus and human Parechovirus. Pediatr Infect Dis J. 2018;37(2):113–118. doi: 10.1097/INF.0000000000001718. - DOI - PubMed
    1. Hui C, Neto G, Tsertsvadze A, Yazdi F, Tricco AC, Tsouros S, et al. Diagnosis and management of febrile infants (0–3 months) Evid Rep Technol Assess (Full Rep) 2012;205:1–297. - PMC - PubMed
    1. Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4- to 8-week-old infants. Pediatrics. 1990;85(6):1040–1043. - PubMed
    1. Aronson PL, Lyons TW, Cruz AT, Freedman SB, Okada PJ, Fleming AH, et al. Impact of Enteroviral polymerase chain reaction testing on length of stay for infants 60 days old or younger. J Pediatr. 2017;189:169–174. doi: 10.1016/j.jpeds.2017.06.021. - DOI - PMC - PubMed
    1. Byington CL, Taggart EW, Carroll KC, Hillyard DR. A polymerase chain reaction-based epidemiologic investigation of the incidence of nonpolio enteroviral infections in febrile and afebrile infants 90 days and younger. Pediatrics. 1999;103(3):E27. doi: 10.1542/peds.103.3.e27. - DOI - PubMed

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