快速肠道病毒聚合酶链反应检测对无细菌性脑膜炎＜90 天发热婴儿管理的影响。
Impact of rapid enterovirus polymerase chain reaction testing on management of febrile young infants < 90 days of age with aseptic meningitis.
机构信息
Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland.
出版信息
BMC Pediatr. 2020 Apr 16;20(1):166. doi: 10.1186/s12887-020-02066-0.
BACKGROUND
Diagnostic evaluation of febrile young infants is challenging. Empirical antimicrobial treatment is therefore common practice in this setting despite high percentage of causative viral infections. The objective of this study was to investigate the impact of rapid enterovirus cerebrospinal fluid polymerase chain reaction (CSF EV PCR) test on hospital length of stay (LOS) and antimicrobial treatment duration in young febrile infants.
METHODS
Retrospective observational study comparing duration of antimicrobial treatment and hospital LOS before (May 1, 2014 - May 30, 2015, untested group) and after (June 1, 2015 - June 30, 2017, tested group) the introduction of rapid CSF EV PCR testing in infants < 90 days of age presenting with fever and CSF pleocytosis at the University Children's Hospital Zurich. Additionally, the same variables were compared after test introduction between CSF EV PCR positive and negative children.
RESULTS
One hundred twenty-eight children were enrolled in the study, 58 before and 70 after the introduction of rapid CSF EV PCR testing. Duration of antimicrobial treatment was significantly shortened in EV positive (n = 42) compared to both EV negative (n = 28) (median 18 h and 48 h, respectively, p < 0.001) and untested patients (n = 58) (median 18 h and 48 h, respectively, p < 0.001), and also in tested compared to untested group patients (median 36 vs 48 h, p < 0.001). Hospital LOS was significantly shortened in EV positive compared to EV negative patients (median 3 days and 4 days respectively, p = 0.013), while an overall reduction was not observed between tested and untested group patients.
CONCLUSIONS
In this study we demonstrate that antimicrobial treatment duration could be significantly shortened in neonates and young infants < 90 days of age with aseptic meningitis after the introduction of a rapid CSF EV PCR test compared to untested patients before test introduction.
背景
发热的婴幼儿的诊断评估具有挑战性。因此，尽管大多数病原体为病毒感染，但经验性抗菌治疗在这种情况下仍很常见。本研究的目的是调查快速肠道病毒脑脊液聚合酶链反应（CSF EV PCR）检测对住院时间（LOS）和年轻发热婴儿抗菌治疗时间的影响。
方法
本研究为回顾性观察性研究，比较了在苏黎世大学儿童医院小于 90 天发热且伴有脑脊液白细胞增多的婴儿引入快速 CSF EV PCR 检测之前（2014 年 5 月 1 日至 2015 年 5 月 30 日，未检测组）和之后（2015 年 6 月 1 日至 2017 年 6 月 30 日，检测组）抗菌治疗时间和住院 LOS。此外，在检测后，还比较了 CSF EV PCR 阳性和阴性儿童之间的相同变量。
结果
本研究共纳入 128 例患儿，其中 58 例在快速 CSF EV PCR 检测前，70 例在快速 CSF EV PCR 检测后。EV 阳性（n=42）患儿的抗菌治疗时间明显短于 EV 阴性（n=28）（中位数 18 小时和 48 小时，均 p<0.001）和未检测患儿（n=58）（中位数 18 小时和 48 小时，均 p<0.001），也短于检测组未检测患儿（中位数 36 小时和 48 小时，p<0.001）。EV 阳性患儿的住院 LOS 明显短于 EV 阴性患儿（中位数 3 天和 4 天，p=0.013），但检测组和未检测组之间未观察到总体减少。
结论
本研究表明，与未检测组患儿相比，在引入快速 CSF EV PCR 检测后，小于 90 天的新生儿和婴儿患有无菌性脑膜炎时，抗菌治疗时间可以显著缩短。
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