title: Impact of a Rapid Herpes Simplex Virus PCR Assay on Duration of Acyclovir Therapy.
abstract: Herpes simplex virus (HSV) infections of the central nervous system (CNS) are associated with significant morbidity and mortality rates in children. This study assessed the impact of a direct HSV (dHSV) PCR assay on the time to result reporting and the duration of acyclovir therapy for children with signs and symptoms of meningitis and encephalitis. A total of 363 patients with HSV PCR results from cerebrospinal fluid (CSF) samples were included in this retrospective analysis, divided into preimplementation and postimplementation groups. For the preimplementation group, CSF testing was performed using a laboratory-developed real-time PCR assay; for the postimplementation group, CSF samples were tested using a direct sample-to-answer assay. All CSF samples were negative for HSV. Over 60% of patients from both groups were prescribed acyclovir. The average HSV PCR test turnaround time for the postimplementation group was reduced by 14.5 h (23.6 h versus 9.1 h;P< 0.001). Furthermore, 79 patients (43.6%) in the postimplementation group had dHSV PCR results reported <4 h after specimen collection. The mean time from specimen collection to acyclovir discontinuation was 17.1 h shorter in the postimplementation group (31.1 h versus 14 h;P< 0.001). The median duration of acyclovir therapy was also significantly reduced in the postimplementation group (29.2 h versus 14.3 h;P= 0.01). Our investigation suggests that implementation of rapid HSV PCR testing can decrease turnaround times and the duration of unnecessary acyclovir therapy.
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.
authors.forename: Tam T
authors.initials: TT
authors.lastname: Van
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.|Keck School of Medicine at the University of Southern California, Los Angeles, California, USA.
authors.forename: Kanokporn
authors.initials: K
authors.lastname: Mongkolrattanothai
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Arevalo
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.
authors.forename: Maryann
authors.initials: M
authors.lastname: Lustestica
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA jdienbard@chla.usc.edu.|Keck School of Medicine at the University of Southern California, Los Angeles, California, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dien Bard
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002490:Central Nervous System / Q000821:virology; D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy*; D018259:Herpesvirus 1, Human / Q000235:genetics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir
keywords: HSV; acyclovir; encephalitis; herpes simplex virus; meningitis; rapid diagnosis; toxicity