943. Should all young febrile infants 60 days of age or younger be tested for enterovirus (EV) in cerebrospinal fluid (CSF) with polymerase chain reaction (PCR)?
Session: Poster Abstract Session: Central Nervous System Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • PosterFinal.pdf (773.2 kB)
  • Background:  PCR testing for EV in CSF samples has been associated with reduced length of stay (LOS) in young, febrile infants and children with aseptic meningitis, particularly those with CSF pleocytosis.  At our institution, collection-to-result turnaround time is £ 24 hours.  However, there are no definite recommendations that guide its use in various clinical scenarios.  We assessed the value of CSF PCR for EV in the evaluation of febrile infants without a source, regardless of CSF pleocytosis and how this management strategy impacts patient care. 

    Methods:  Retrospective review (4/1/10-9/30/10) of medical records of infants £ 60 days admitted for rule-out sepsis (including fever without source, apnea, apparent life-threatening event, seizures, and/or any other concerning presentation for which bacterial cultures and/or viral tests were obtained).  Data were cross-referenced with virology records to identify the study population.  From a total of 205 infants, 110 (54%) met the study criteria: a) non-blood CSF sample, b) negative CSF bacterial cultures, and c) CSF PCR testing for EV. 

    Results: CSF PCR was positive for EV in 26/110 (23.6%) infants.  Of these positives, pleocytosis (CSF WBC > 14 cells/ml in infants £ 30 d; > 3 cells in those 31-60 d) was absent in 11/17 (64.7%) of infants £ 30 days of age in 3/9 (33.3%) of those aged 31 to 60 days.  Including only febrile (either reported or documented) infants who tested positive for EV in CSF samples (25/82) did not impact the rate of finding EV positive CSF PCR in the absence of pleocytosis.  Compared to those with negative PCR testing for EV in CSF samples, mean LOS and total costs were decreased 1.609 days (p £ 0.0002) and over $10,000 (p £ 0.0001) for the positive patients.  Mean LOS and total costs were 1.162 days (p £ 0.0006) and over $6,000 (p £ 0.0008) less for the febrile infants whose CSF PCR tested EV positive compared to those with fever who tested negative. 

    Conclusion: CSF PCR testing for EV in young febrile infants should not be limited to infants with CSF pleocytosis.  Consideration should be given to routine testing for EV in all infants £ 60 days of age presenting with fever and/or suspected infection.

     


    Subject Category: P. Pediatric and perinatal infections

    Domenico Pietropaolo, MD, Department of Pediatrics, Section of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, Carol Kao, The Ohio State University College of Medicine, Columbus, OH, William Barson, MD, Department of Pediatrics, Section of Infectious Diseases, Nationwide Children's Hospital (NCH) and The Ohio State University College of Medicine, Columbus, OH and Octavio Ramilo, MD, Pediatrics, Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH

    Disclosures:

    D. Pietropaolo, None

    C. Kao, None

    W. Barson, None

    O. Ramilo, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.