Detection of enterovirus in cerebrospinal fluids without pleocytosis in febrile infants under 3 months old reduces antibiotherapy duration

Abstract

BackgroundInfants under 3 months old with fever often receive empirical antibiotic treatment. Enterovirus 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.MethodsDuring 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.Results92 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], p < 0.001. No clinical nor biological features differed according to the enterovirus status.ConclusionIn 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.

Enterovirus Central Nervous System Infection in Infancy, the Value of Routine Testing

“…A recent French study found that febrile infants without CSF pleocytosis who tested positive for EV received a shorter duration of antibiotics than those who were either not tested or tested negative. 7 Most EV cases are benign and can be easily treated at home with supportive measures and reassurance. Timely, ideally in-house availability of EV RT-PCR may facilitate early discharge home.…”

“…6 This study highlights the importance of systematically testing for EV in febrile infants. A systematic review in 2017 7 found that routine EV testing was associated with decreased hospital stay and cost savings in febrile infants under 3 months. A recent French study found that febrile infants without CSF pleocytosis who tested positive for EV received a shorter duration of antibiotics than those who were either not tested or tested negative.…”

“…A recent French study found that febrile infants without CSF pleocytosis who tested positive for EV received a shorter duration of antibiotics than those who were either not tested or tested negative. 7…”