Blachez Marion, Boussier Jeremy, Mariani Patricia, Caula Caroline, Gaschignard Jean, Lefèvre-Utile Alain
General Pediatrics and Pediatric Emergency Department, Saint Camille Hospital, Bry-sur-Marne, France.
Sorbonne Université, La Pitié Salpêtrière Hospital, Paris, France.
Front Pediatr. 2023 Feb 28;11:1122460. doi: 10.3389/fped.2023.1122460. eCollection 2023.
Infants under 3 months old with fever often receive empirical antibiotic treatment. is one of the leading causes of infection and aseptic meningitis but is not systematically screened. We aimed to evaluate enterovirus positive RT-PCR proportion in cerebrospinal fluid (CSF) with no pleocytosis and its impact on antibiotic treatment duration.
During the enterovirus endemic season, from 2015 to 2018, we retrospectively studied infants under 3 months old, consulting for fever without cause, with normal CSF analysis, and receiving empirical antibiotic treatment. Clinical and biological data were analyzed, notably enterovirus RT-PCR results. The primary outcome was the duration of antibiotic therapy.
92 patients were recruited. When tested, 41% of infants were positive for enterovirus, median antibiotic duration was reduced in enterovirus positive in comparison to negative patients with respectively 1.9 [interquartile range (IQR), 1.7-2] vs. 4.1 [IQR, 2-6], < 0.001. No clinical nor biological features differed according to the enterovirus status.
In this population, enterovirus positive CSF are frequent despite the absence of pleocytosis. However, its research was not guided by clinical or biological presentations. Systematic and routine use of enterovirus RT-PCR during enterovirus season, regardless of CSF cell count, could reduce the prescription of antibiotics in febrile infants under 3 months old without clinical orientation.
3个月以下发热婴儿常接受经验性抗生素治疗。肠道病毒是感染和无菌性脑膜炎的主要病因之一，但未进行系统筛查。我们旨在评估脑脊液（CSF）中无细胞增多的肠道病毒阳性逆转录聚合酶链反应（RT-PCR）比例及其对抗生素治疗持续时间的影响。
在2015年至2018年肠道病毒流行季节，我们回顾性研究了3个月以下因不明原因发热前来就诊、脑脊液分析正常且接受经验性抗生素治疗的婴儿。分析了临床和生物学数据，尤其是肠道病毒RT-PCR结果。主要结局是抗生素治疗的持续时间。
共纳入92例患者。检测时，41%的婴儿肠道病毒呈阳性，与阴性患者相比，肠道病毒阳性患者的抗生素中位使用时间缩短，分别为1.9天[四分位间距（IQR），1.7 - 2天]对4.1天[IQR，2 - 6天]，<0.001。根据肠道病毒状态，临床和生物学特征均无差异。
在该人群中，尽管无细胞增多，但脑脊液肠道病毒阳性很常见。然而，其检测并非由临床或生物学表现所指导。在肠道病毒流行季节，无论脑脊液细胞计数如何，系统且常规地使用肠道病毒RT-PCR检测，可减少3个月以下无临床明确病因发热婴儿的抗生素处方。
