title: Benefits of management strategy adjustments during an outbreak of enterovirus meningitis in adults.
abstract: Enteroviruses (EVs) are the most common identifiable cause of the aseptic meningitis syndrome. Widespread seasonal outbreaks of EV meningitis result in a high financial cost to the community, in part because of the difficulty of discriminating between viral and bacterial meningitis. During a nationwide outbreak of EV meningitis due to echovirus 30 in France we tested the hypothesis that a management strategy including early testing of cerebrospinal fluid (CSF) by means of EV PCR in all adult patients with acute aseptic meningitis on admission might reduce the duration of hospitalization and thus the expenditure on health resources. We compared the characteristics of adult patients with acute aseptic meningitis seen in our institution before (n = 21) and after (n = 27) implementation of this strategy. The strategy was cost-effective in that it significantly reduced (i) the mean duration of hospital stay (from 103 to 80 h; p = 0.04); and (ii) the mean duration of antibacterial treatment (from 115 to 69 h; p = 0.02). Systematic testing of CSF in adult patients with aseptic meningitis by means of EV PCR may be cost-effective during an outbreak of EV meningitis.
authors.affiliation: Infectious Diseases Unit, Pontchaillou University Hospital, Rennes, France. pierre.tattevin@chu-rennes.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.forename: Sophie
authors.initials: S
authors.lastname: Minjolle
authors.forename: Cédric
authors.initials: C
authors.lastname: Arvieux
authors.forename: Valérie
authors.initials: V
authors.lastname: Clayessen
authors.forename: Ronald
authors.initials: R
authors.lastname: Colimon
authors.forename: Jacques
authors.initials: J
authors.lastname: Bouget
authors.forename: Christian
authors.initials: C
authors.lastname: Michelet
mesh_terms: D000293:Adolescent; D000328:Adult; D002555:Cerebrospinal Fluid / Q000821:virology*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D004196:Disease Outbreaks; D029822:Enterovirus B, Human / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008582:Meningitis, Aseptic / Q000453:epidemiology / Q000821:virology; D008587:Meningitis, Viral / Q000453:epidemiology / Q000628:therapy / Q000821:virology*; D016133:Polymerase Chain Reaction / Q000191:economics*