title: Rapid detection of enterovirus in cerebrospinal fluid by a fully-automated PCR assay is associated with improved management of aseptic meningitis in adult patients.
abstract: BACKGROUND
  Enterovirus (EV) is the most frequent cause of aseptic meningitis (AM). Lack of microbiological documentation results in unnecessary antimicrobial therapy and hospitalization.
  
  
  OBJECTIVE
  To assess the impact of rapid EV detection in cerebrospinal fluid (CSF) by a fully-automated PCR (GeneXpert EV assay, GXEA) on the management of AM.
  
  
  METHODS
  Observational study in adult patients with AM. Three groups were analyzed according to EV documentation in CSF: group A = no PCR or negative PCR (n=17), group B = positive real-time PCR (n = 20), and group C = positive GXEA (n = 22). Clinical, laboratory and health-care costs data were compared.
  
  
  RESULTS
  Clinical characteristics were similar in the 3 groups. Median turn-around time of EV PCR decreased from 60 h (IQR (interquartile range) 44-87) in group B to 5h (IQR 4-11) in group C (p<0.0001). Median duration of antibiotics was 1 (IQR 0-6), 1 (0-1.9), and 0.5 days (single dose) in groups A, B, and C, respectively (p < 0.001). Median length of hospitalization was 4 days (2.5-7.5), 2 (1-3.7), and 0.5 (0.3-0.7), respectively (p < 0.001). Median hospitalization costs were $5458 (2676-6274) in group A, $2796 (2062-5726) in group B, and $921 (765-1230) in group C (p < 0.0001).
  
  
  CONCLUSIONS
  Rapid EV detection in CSF by a fully-automated PCR improves management of AM by significantly reducing antibiotic use, hospitalization length and costs.
authors.affiliation: Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland. Electronic address: stefano.giulieri@chuv.ch.
authors.forename: Stefano G
authors.initials: SG
authors.lastname: Giulieri
authors.affiliation: Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Caroline
authors.initials: C
authors.lastname: Chapuis-Taillard
authors.affiliation: Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Oriol
authors.initials: O
authors.lastname: Manuel
authors.affiliation: Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hugli
authors.affiliation: Health Technology Assessment Unit, Medical Direction, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Pinget
authors.affiliation: Health Technology Assessment Unit, Medical Direction, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Jean-Blaise
authors.initials: JB
authors.lastname: Wasserfallen
authors.affiliation: Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Sahli
authors.affiliation: Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Katia
authors.initials: K
authors.lastname: Jaton
authors.affiliation: Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Oscar
authors.initials: O
authors.lastname: Marchetti
authors.affiliation: Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland. Electronic address: pascal.meylan@chuv.ch.
authors.forename: Pascal
authors.initials: P
authors.lastname: Meylan
mesh_terms: D000328:Adult; D019468:Disease Management; D004770:Enterovirus / Q000235:genetics*; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000191:economics / Q000379:methods; D012367:RNA, Viral / Q000235:genetics; D055815:Young Adult
chemical_list: D012367:RNA, Viral
keywords: CSF; Enterovirus; Management; Meningitis; PCR; Rapid