Routine Use of a PCR Test Reduces Hospitalization and Antibiotic Use for Infants Evaluated for Meningitis

01/25/2008

Affecting an estimated 75,000 children in the United States each year, aseptic meningitis, also called viral meningitis, is a common pediatric infection. The infection resolves without treatment and rarely leads to serious complications. However, it is difficult to distinguish between young infants with viral meningitis and those with more serious causes of infection.

Infants often lack the classic signs of aseptic meningitis seen in older children, and infants' cerebrospinal fluid (CSF) may not always have the CSF white blood cell count abnormalities that characterize viral meningitis in older children. As a consequence, many of these patients are hospitalized to receive broad-spectrum antibiotics while awaiting the results of bacterial cultures of the CSF, a costly method of care.

Reverse transcriptase-polymerase chain reaction (PCR)-based testing for enterovirus in CSF allows for rapid diagnosis of infants with the most common cause of viral meningitis. At most hospitals, enterovirus PCR test results are not typically available in a timely manner. However, performing this test at frequent intervals has the potential to solve the problems associated with prolonged hospitalization and excessive antibiotic use for infants with viral meningitis.

Children's Hospital investigators found that CSF enterovirus PCR testing reduced the length of hospitalization and duration of antibiotic use for infants younger than 90 days. Led by Samir Shah, M.D., M.S.C.E., Division of Infectious Diseases, this is the first study specifically examining the effect of PCR testing on hospital length of stay while controlling for other factors associated with prolonged hospitalization, and the first to demonstrate the impact of this test in a large cohort of young infants.

Using data from 478 Children's Hospital patients less than 90 days of age who had CSF enterovirus PCR testing during the enteroviral seasons of 2000 to 2006, investigators assessed the length of hospitalization and the duration of antibiotic use. They found that having a positive CSF enterovirus PCR result was associated with a 1.54-day decrease in the length of hospital stay and a 33.7 percent shorter duration of antibiotic use.

The goal of the study was to define a population of children for whom CSF enterovirus PCR should be ordered as part of the initial diagnostic evaluation. The investigators found that this test should be considered for all young infants presenting with suspected meningitis during the enteroviral season, from June 1 through October 31.

"We found that that routine PCR tests can improve the efficiency of care by dramatically shortening the length of hospitalization and reducing antibiotic use by about one-third," says Dr. Shah. "Also, when CSF enterovirus PCR results are available rapidly, they play a key role in discharge decisions, which has the potential to result in significant cost savings during periods of peak enterovirus activity."

Study co-authors, all from Children's Hospital and the University of Pennsylvania School of Medicine, are Rebecca L. King, M.D., Scott A. Lorch, M.D., M.S.C.E., Daniela M. Cohen, B.S., Richard L. Hodinka, Ph.D., and Keri A. Cohn, M.D.