On-site Multiplex PCR for CSF diagnostics in an Acute Hospital versus Referral to Reference Laboratories: Assessing Economic Factors, Length of Stay and Antimicrobial Stewardship.

Barry, Rachel; Dempsey, Catherine; Barry, Louise; Hooton, Carmel; Connor, Antoinette O'; Reynolds, Clare M.; Cremin, M.; Felsenstein, Susanna; Cunney, Robert; Dean, Jonathan; Corcoran, G.D.

doi:10.1016/j.jinf.2020.10.004

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Timely, ideally in-house availability of EV RT-PCR may facilitate early discharge home. 8 In our study of children with confirmed EV results the median length of stay was 3 days and the median duration of antibiotics was 2 days, suggesting that EV testing facilitated early discontinuation of antibiotics and discharge home. However, at present, local and international guidelines for the evaluation of febrile infants, such as the American Academy of Pediatrics Guideline for Evaluation and Management of Well-Appearing Febrile Infants 8–60 Days Old 9 or the National Institute of Healthcare Excellence (NICE) Guideline for management of febrile children under 5 years, 10 do not include EV testing.…”

Section: Discussionmentioning

confidence: 61%

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

Giva,

Barry,

Drew

et al. 2023

Pediatric Infectious Disease Journal

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Background: Human nonpolio enterovirus (EV) is a major cause of infection in neonates and infants; however, the clinical presentation and cerebrospinal fluid findings vary significantly. Infection caused by EV in patients under 1 year of age can present with a broad clinical spectrum, from fever to severe systemic and/or neurological disease. Methods: Retrospective cohort analysis of infants with EV central nervous system (CNS) infection presenting to a tertiary center between January 2017 and December 2022. We recorded patient demographics, parent-reported symptoms at presentation, and blood and cerebrospinal fluid (CSF) testing at presentation. Results: Seventy-eight patients were included in the final study. Forty-one percent of infants with an EV CNS infection had a normal CSF white blood cell count. Clinical presentation was similar in infants with and without CSF pleocytosis. Median C-reactive protein was higher in cases of EV CNS infection without pleocytosis. Conclusion: EV CNS infection commonly presents without CSF pleocytosis. Testing for EV should be considered in febrile infants with no source regardless of CSF parameters.

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Section: Discussionmentioning

confidence: 61%

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

Giva,

Barry,

Drew

et al. 2023

Pediatric Infectious Disease Journal

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“…It has been reported in other work involving the multiplex ME panel that changes to empiric therapy are made after positive results are received in the majority of cases [ 29 , 30 ]. Furthermore, in a study conducted in Colombia, the introduction of the multiplex ME panel decreased time to targeted therapy from 195 to 2.1 h [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Impact of a Meningitis/Encephalitis Panel on Hospital Length of Stay: A Systematic Review and Meta-Analysis

et al. 2022

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Meningitis and encephalitis are central nervous system infections with considerable morbidity and mortality. The BioFire® FilmArray® Meningitis/Encephalitis Panel (multiplex ME panel) can identify pathogens rapidly potentially aiding in targeted therapy and curtail antimicrobial exposure. This systematic review and meta-analysis synthesized the literature on the association between the multiplex ME panel and length of hospital stay (LOS), length of acyclovir therapy, and days with antibiotics. MEDLINE and EMBASE were searched. Only studies presenting novel data were retained. Random-effects meta-analyses were performed to assess the impact of the multiplex ME panel on outcomes. Of 169 retrieved publications, 13 met the criteria for inclusion. Patients tested with the multiplex ME panel had a reduction in the average LOS (mean difference [MD] [95% CI]: −1.20 days [−1.96, −0.44], n=11 studies). Use of the multiplex ME panel was also associated with a reduction in the length of acyclovir therapy (MD [95% CI]: −1.14 days [−1.78, −0.50], n=7 studies) and a nonsignificant reduction in the average number of days with antibiotics (MD [95% CI]: −1.01 days [−2.39, 0.37], n=6 studies). The rapidity of pathogen identification contributes to an overall reduced LOS, reductions in the duration of empiric antiviral utilization, and a nonsignificant reduction in antibiotic therapy.

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“…All children who presented to Cork University Hospital, Cork, Ireland, between January 2014 and December 2019, and whose CSF tested positive by polymerase chain reaction for EV and hPeV were included. 20,21 The National Virus Reference Laboratory (University College Dublin) provided typing of entero- and parechovirus RNA where available.…”

Section: Methodsmentioning

confidence: 99%

Parent-administered Neurodevelopmental Follow up in Children After Picornavirus CNS Infections

Stephens

Reynolds

Cremin

et al. 2021

Pediatric Infectious Disease Journal

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Background: Data on the neurodevelopment of children who experienced central nervous system (CNS) infections with enteroviruses (EV) or parechoviruses (hPeV) is scarce and mostly limited to follow up of short-term outcomes. Methods: Parents of children who presented between 2014 and 2019, underwent a lumbar puncture and whose cerebrospinal fluid was polymerase chain reaction positive for EV or hPeV, were asked to complete a care-giver-administered neurodevelopmental assessment tool (The Ages and Stages Instrument [ASQ3]). Clinical data of the infective episode were collected from patient notes. Results: Of 101 children, 43 (10 hPeV+, 33 EV+) submitted ASQ3 results. Median age at assessment was 38.9 months (interquartile range, 15.4-54.8), the follow-up interval 3 years (median 37 months; interquartile range, 13.9-53.1). Age, inflammatory markers, and cerebrospinal fluid pleocytosis during the infective event were not associated with ASQ3 scores. In 23 children (17 EV+, 6 hPeV+), no neurodevelopmental concerns were reported. Two more had preexisting developmental delay and were excluded. Of the remaining, 18/41 (43.9%) reported ASQ3 scores indicating need for monitoring or professional review in at least 1 category, not differing by pathogen (EV 14/31, 45.2%; hPeV 4/10, 40%; P = 0.71). Seven children will require formal review, scoring ≥2 SD below the mean in at least 1 category (6/31 EV+, 1/10 hPeV+, P = 0.7), 3 scored ≥2 SD below the mean in more than 1 area. Conclusions: Parent-administered developmental assessment of children with a history of early picornavirus infection of the CNS identified a subgroup that requires formal neurodevelopmental review. Wider application of community-based developmental screening will complement our understanding of the impact of CNS infections in early childhood.

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On-site Multiplex PCR for CSF diagnostics in an Acute Hospital versus Referral to Reference Laboratories: Assessing Economic Factors, Length of Stay and Antimicrobial Stewardship.

Cited by 4 publications

References 5 publications

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

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

Assessment of the Impact of a Meningitis/Encephalitis Panel on Hospital Length of Stay: A Systematic Review and Meta-Analysis

Parent-administered Neurodevelopmental Follow up in Children After Picornavirus CNS Infections

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