title: Suboptimal management of central nervous system infections in children: a multi-centre retrospective study.
abstract: OBJECTIVE
  We aimed to audit the regional management of central nervous system (CNS) infection in children.
  
  
  METHODS
  The study was undertaken in five district general hospitals and one tertiary paediatric hospital in the Mersey region of the UK. Children admitted to hospital with a suspected CNS infection over a three month period were identified. Children were aged between 4 weeks and 16 years old. Details were recorded from the case notes and electronic records. We measured the appropriateness of management pathways as outlined by national and local guidelines.
  
  
  RESULTS
  Sixty-five children were identified with a median age of 6 months (range 1 month to 15 years). Ten had a CNS infection: 4 aseptic meningitis, 3 purulent meningitis, 3 encephalitis [2 with herpes simplex virus (HSV) type 1]. A lumbar puncture (LP) was attempted in 50 (77%) cases but only 43 had cerebrospinal fluid (CSF) available for analysis. Of these 24 (57%) had a complete standard set of tests performed. Fifty eight (89%) received a third generation cephalosporin. Seventeen (26%) also received aciclovir with no obvious indication in 9 (53%). Only 11 (65%) of those receiving aciclovir had CSF herpes virus PCR. Seventeen had cranial imaging and it was the first management step in 14. Treatment lengths of both antibiotics and aciclovir were highly variable: one child with HSV encephalitis was only treated with aciclovir for 7 days.
  
  
  CONCLUSIONS
  The clinical management of children with suspected CNS infections across the Mersey region is heterogeneous and often sub-optimal, particularly for the investigation and treatment of viral encephalitis. National guidelines for the management of viral encephalitis are needed.
authors.affiliation: Neurological Infectious Disease, Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Kelly
authors.forename: Aman
authors.initials: A
authors.lastname: Sohal
authors.forename: Benedict D
authors.initials: BD
authors.lastname: Michael
authors.forename: Andrew
authors.initials: A
authors.lastname: Riordan
authors.forename: Tom
authors.initials: T
authors.lastname: Solomon
authors.forename: Rachel
authors.initials: R
authors.lastname: Kneen
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004660:Encephalitis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D020803:Encephalitis, Herpes Simplex / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D004739:England; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D018259:Herpesvirus 1, Human; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D002511:Cephalosporins; D000212:Acyclovir