Impact on hospital length of stay and antimicrobial usage in children diagnosed with viral meningitis by rapid multiplexed PCR assay

Abstract

Meningitis and encephalitis can lead to severe morbidity and result in permanent neurologic deficits in children, but outcomes differ depending on the causative pathogen. Early diagnosis of viral meningitis may allow for appropriate management, including avoidance of antimicrobial treatment and hospital admission. We sought to determine the clinical utility of a multiplexed meningitis-encephalitis (ME) panel at a quaternary care pediatric institution in patients diagnosed with human enterovirus (HEV) and human parechovirus (HPeV) meningitis. Retrospective analysis of patients between June 2016 and October 2023 positive for HEV or HPeV (n = 66) by ME panel were compared to HEV or HPeV positive patients (n = 53) diagnosed by standalone PCR (polymerase chain reaction) between December 2011 and May 2016. The turnaround time (TAT) for ME panel was 2.67 h compared to 22.05 h for standalone polymerase chain reaction (PCR) (p < 0.0001). In patients with cerebrospinal fluid (CSF) collected and tested by ME panel within 72 h of admission compared to standalone PCR, the duration of intravenous acyclovir therapy was significantly reduced (3.88 vs 16.03 h, P = 0.03). Despite viral detection by molecular methods, patients remained on antibiotics until CSF cultures were confirmed to be negative after 48 h of incubation. Implementation of ME panel in a pediatric hospital improved overall time to diagnosis of viral (or aseptic) ME. Although not statistically significant, the median length of stay (LOS) of patients positive for HEV or HPeV by ME panel was reduced by 0.51 days when compared to standalone PCR (1.95 vs. 2.46 days, p = 0.66).