Rapid detection of enterovirus in cerebrospinal fluid by a fully-automated PCR assay is associated with improved management of aseptic meningitis in adult patients

Abstract

BackgroundEnterovirus (EV) is the most frequent cause of aseptic meningitis (AM). Lack of microbiological documentation results in unnecessary antimicrobial therapy and hospitalization. ObjectivesTo assess the impact of rapid EV detection in cerebrospinal fluid (CSF) by a fully-automated PCR (GeneXpert EV assay, GXEA) on the management of AM. Study designObservational study in adult patients with AM. Three groups were analyzed according to EV documentation in CSF: group A=no PCR or negative PCR (n=17), group B=positive real-time PCR (n=20), and group C=positive GXEA (n=22). Clinical, laboratory and health-care costs data were compared. ResultsClinical characteristics were similar in the 3 groups. Median turn-around time of EV PCR decreased from 60h (IQR (interquartile range) 44–87) in group B to 5h (IQR 4–11) in group C (p<0.0001). Median duration of antibiotics was 1 (IQR 0–6), 1 (0–1.9), and 0.5 days (single dose) in groups A, B, and C, respectively (p<0.001). Median length of hospitalization was 4 days (2.5–7.5), 2 (1–3.7), and 0.5 (0.3–0.7), respectively (p<0.001). Median hospitalization costs were $5458 (2676–6274) in group A, $2796 (2062–5726) in group B, and $921 (765–1230) in group C (p<0.0001). ConclusionsRapid EV detection in CSF by a fully-automated PCR improves management of AM by significantly reducing antibiotic use, hospitalization length and costs.