Van Tam T, Mongkolrattanothai Kanokporn, Arevalo Melissa, Lustestica Maryann, Dien Bard Jennifer
Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.
Division of Infectious Diseases, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.
J Clin Microbiol. 2017 May;55(5):1557-1565. doi: 10.1128/JCM.02559-16. Epub 2017 Mar 8.
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; < 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; < 0.001). The median duration of acyclovir therapy was also significantly reduced in the postimplementation group (29.2 h versus 14.3 h; = 0.01). Our investigation suggests that implementation of rapid HSV PCR testing can decrease turnaround times and the duration of unnecessary acyclovir therapy.
单纯疱疹病毒（HSV）感染中枢神经系统（CNS）会导致儿童出现较高的发病率和死亡率。本研究评估了直接HSV（dHSV）聚合酶链反应（PCR）检测对报告结果所需时间以及患有脑膜炎和脑炎体征及症状的儿童接受阿昔洛韦治疗持续时间的影响。本回顾性分析共纳入363例脑脊液（CSF）样本有HSV PCR检测结果的患者，分为实施前组和实施后组。对于实施前组，使用实验室自行开发的实时PCR检测法进行CSF检测；对于实施后组，使用直接样本到答案检测法对CSF样本进行检测。所有CSF样本的HSV检测均为阴性。两组中超过60%的患者接受了阿昔洛韦治疗。实施后组的HSV PCR检测平均周转时间缩短了14.5小时（分别为23.6小时和9.1小时；<0.001）。此外，实施后组中有79例患者（43.6%）在样本采集后<4小时就获得了dHSV PCR检测结果。实施后组从样本采集到停用阿昔洛韦的平均时间缩短了17.1小时（分别为31.1小时和14小时；<0.001）。实施后组阿昔洛韦治疗的中位持续时间也显著缩短（分别为29.2小时和14.3小时；=0.01）。我们的研究表明，实施快速HSV PCR检测可缩短周转时间并减少不必要的阿昔洛韦治疗持续时间。
