Key result
Detection of enterovirus in cerebrospinal fluid without pleocytosis significantly reduced median antibiotic duration to 1.9 days compared to 4.1 days in enterovirus-negative febrile infants under 3 months old.
Why the study?
Infants under 3 months old with fever often receive empirical antibiotics, and enterovirus causes aseptic meningitis without systematic screening.
Does enterovirus positive RT-PCR in cerebrospinal fluid without pleocytosis reduce antibiotic treatment duration in febrile infants under 3 months old?
Observational (n=92)
No
Does enterovirus positive RT-PCR in cerebrospinal fluid without pleocytosis reduce antibiotic treatment duration in febrile infants under 3 months old?
Absolute Event Rate: 1.9% vs 4.1%
p-value: p=<0.001
Systematic enterovirus RT-PCR testing in febrile infants under 3 months old with normal CSF cell counts during endemic seasons can significantly reduce the duration of empirical antibiotic therapy.
May support enterovirus testing to shorten antibiotics in febrile young infants without pleocytosis; leaves open prospective validation.
Background Infants under 3 months old with fever often receive empirical antibiotic treatment. Enterovirus is one of the leading causes of infection and aseptic meningitis but is not systematically screened. We aimed to evaluate enterovirus positive RT-PCR proportion in cerebrospinal fluid (CSF) with no pleocytosis and its impact on antibiotic treatment duration. Methods During the enterovirus endemic season, from 2015 to 2018, we retrospectively studied infants under 3 months old, consulting for fever without cause, with normal CSF analysis, and receiving empirical antibiotic treatment. Clinical and biological data were analyzed, notably enterovirus RT-PCR results. The primary outcome was the duration of antibiotic therapy. Results 92 patients were recruited. When tested, 41% of infants were positive for enterovirus, median antibiotic duration was reduced in enterovirus positive in comparison to negative patients with respectively 1.9 [interquartile range (IQR), 1.7–2] vs. 4.1 [IQR, 2–6], p < 0.001. No clinical nor biological features differed according to the enterovirus status. Conclusion In this population, enterovirus positive CSF are frequent despite the absence of pleocytosis. However, its research was not guided by clinical or biological presentations. Systematic and routine use of enterovirus RT-PCR during enterovirus season, regardless of CSF cell count, could reduce the prescription of antibiotics in febrile infants under 3 months old without clinical orientation.
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Blachez et al. (2023) conducted an observational in Fever without source (n=92). Enterovirus positive RT-PCR in CSF vs. Enterovirus negative RT-PCR was evaluated on Duration of antibiotic therapy (p=<0.001). Detection of enterovirus in cerebrospinal fluid without pleocytosis significantly reduced median antibiotic duration to 1.9 days compared to 4.1 days in enterovirus-negative febrile infants under 3 months old.
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