Key result
The introduction of rapid CSF EV PCR testing significantly shortened the median duration of antimicrobial treatment from 48 hours to 36 hours in febrile infants < 90 days of age with aseptic meningitis.
Why the study?
Diagnostic evaluation of febrile young infants is challenging, leading to common empirical antimicrobial treatment despite a high percentage of viral infections. The study investigated the impact of rapid enterovirus CSF PCR testing on hospital length of stay and antimicrobial duration.
Does rapid CSF EV PCR testing reduce antimicrobial treatment duration and hospital length of stay in febrile young infants < 90 days of age with aseptic meningitis?
Observational (n=128)
No
Does rapid CSF EV PCR testing reduce antimicrobial treatment duration and hospital length of stay in febrile young infants < 90 days of age with aseptic meningitis?
Absolute Event Rate: 36% vs 48%
p-value: p=<0.001
The implementation of rapid CSF EV PCR testing significantly reduces the duration of empirical antimicrobial treatment in febrile young infants with aseptic meningitis.
May reduce unnecessary antimicrobial exposure in febrile infants; leaves open the need for prospective validation before practice change.
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.
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Paioni et al. (2020) conducted an observational in Aseptic meningitis in febrile young infants (n=128). Rapid enterovirus cerebrospinal fluid polymerase chain reaction (CSF EV PCR) testing vs. Untested group (before introduction of the test) was evaluated on Duration of antimicrobial treatment (median hours) (p=<0.001). The introduction of rapid CSF EV PCR testing significantly shortened the median duration of antimicrobial treatment from 48 hours to 36 hours in febrile infants < 90 days of age with aseptic meningitis.
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