ABSTRACT Background: Clinical prediction rules using the results of lumbar puncture do not accurately distinguish aseptic meningitis from bacterial meningitis in infants in the first few months of life. Cerebrospinal fluid (CSF) enterovirus polymerase chain reaction (PCR) testing can help guide clinicians in the management of febrile infants because it provides for accurate and rapid diagnosis of infants with the most common form of aseptic meningitis.
Objectives: To determine whether CSF enterovirus PCR testing of febrile neonates is associated with a shortened LOS.
Methods: This retrospective cohort study included febrile infants ≤ 56 days of age evaluated by lumbar puncture at a large children’s hospital between January 1, 2005 and December 31, 2007. The primary exposure was performance of CSF enterovirus PCR testing and the primary outcome was hospital length of stay (LOS).
Results: CSF enterovirus PCR was performed in 361 (29.3%) of 1231 eligible infants; 89 (24.7%) of those tested were positive. The median LOS was 2 days. In multivariable analysis, CSF enterovirus PCR testing was associated with a shortened LOS for subjects with a positive result compared with those not tested, while a negative result was associated with no change in LOS. Further stratification demonstrated shorten LOS for all infants 0-28 days who tested positive regardless of receipt of antibiotics prior to lumbar puncture. For infants 29-56 days, a positive test was associated with a decrease in LOS for patients who did not receive antibiotics prior to lumbar puncture. The median turnaround time for CSF enterovirus PCR testing was 22.2 hours (IQR: 15.1-27.2) with no effect of turnaround time on LOS.
Conclusions: In febrile infants and neonates, a positive CSF enterovirus PCR test is associated with a shortened LOS as compared with no testing. Negative tests were not associated with a longer LOS. CSF enterovirus PCR testing may improve the efficiency of care for neonate and young infants presenting for fever.