Impact of rapid polymerase chain reaction results on management of pediatric patients with enteroviral meningitis.
BACKGROUND
Enterovirus (EV) infections can be rapidly detected by PCR. However, several studies suggest that results must be available early in the management of the patient to impact significantly on patient care. We evaluated this hypothesis directly during an outbreak of EV aseptic meningitis.


METHODS
From June through November, 1998, EV PCR was performed 5 days a week on cerebrospinal fluid specimens from pediatric patients evaluated for meningitis. We compared antibiotic use, length of stay and hospital charges in a group of patients with EV meningitis whose positive EV PCR results were available within 24 h of specimen collection, to a group of similar patients whose results were available >24 h after collection.


RESULTS
Cerebrospinal fluid specimens were submitted for EV PCR from 113 patients with suspected EV meningitis, and 50 of 113 (44%) were positive. Of these 50 EV-PCR-positive patients, 17 of 50 (34%) had EV PCR results available in < or = 24 h and 33 of 50 (66%) had results available in >24 h. Patients with EV-positive results reported < or = 24 h after specimen collection had 20 h less of antibiotic use (P = 0.006) and $2,798 less in hospital charges (P = 0.001) than patients with positive results available in >24 h. Hospitalized patients who received positive results rapidly did not have significantly less antibiotic therapy or shorter length of stay, but hospital charges were reduced by $2,331 (P = 0.009).


CONCLUSIONS
Rapid reporting of PCR results can have a significant impact on several outcome measures for patients with EV meningitis.
Robinson
Christine C
CC
Department of Pathology, The Children's Hospital and the University of Colorado Health Sciences Center, Denver 80218, USA. robinson.christine@tchden.org
Willis
Mary
M
Meagher
Ashley
A
Gieseker
Karen E
KE
Rotbart
Harley
H
Glodé
Mary P
MP
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis*; D003937:Diagnosis, Differential; D004770:Enterovirus / Q000235:genetics* / Q000472:pathogenicity; D004769:Enterovirus Infections / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004279:DNA, Viral