Advertisement

Impact of decreasing cerebrospinal fluid enterovirus PCR turnaround time on costs and management of children with suspected enterovirus meningitis

Abstract

To estimate the impact of implementing in-hospital enterovirus (EV) polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) with same-day turn-around-time (TAT) on length-of-stay (LOS), antibiotic use and on cost per patient with suspected EV meningitis, compared with testing at an outside reference laboratory. A model-based analysis using a retrospective cohort of all hospitalized children with CSF EV PCR testing done between November 2013 and 2017. The primary outcome measured was the potential date of discharge if the EV PCR result had been available on the same day. Patients with positive EV PCR were considered for potential earlier discharge once clinically stable with no reason for hospitalization other than intravenous antibiotics. Descriptive statistics and cost-sensitivity analyses were performed. CSF EV PCR testing was done on 153 patients, of which 44 (29%) had a positive result. Median test TAT was 5.3 days (IQR 3.9–7.6). Median hospital LOS was 5 days (IQR 3–12). Most (86%) patients received intravenous antibiotics with mean duration of 5.72 ± 6.51 days. No patients with positive EV PCR had a serious bacterial infection. We found that same-day test TAT would reduce LOS and duration of intravenous antibiotics by 0.50 days (95%CI 0.33–0.68) and 0.67 days (95%CI 0.42–0.91), respectively. Same-day test TAT was associated with a cost reduction of 342.83CAD (95%CI 178.14–517.00) per patient with suspected EV meningitis. Compared with sending specimens to a reference laboratory, performing CSF EV PCR in-hospital with same-day TAT was associated with decreased LOS, antibiotic therapy, and cost per patient.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

CAD:

Canadian dollar

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

EV:

Enterovirus

LOS:

Length of stay

MUHC:

McGill University Health Centre

PCR:

Polymerase chain reaction

SBI:

Serious bacterial infection

TAT:

Turn-around-time

References

  1. 1.

    Rotbart HA (1995) Enteroviral infections of the central nervous system. Clin Infect Dis 20(4):971–981

  2. 2.

    Rudolph H, Schroten H, Tenenbaum T (2016) Enterovirus infections of the central nervous system in children: an update. Pediatr Infect Dis J 35(5):567–569

  3. 3.

    Wallace SS, Lopez MA, Caviness AC (2017) Impact of enterovirus testing on resource use in febrile young infants: a systematic review. Hosp Pediatr 7(2):96–102

  4. 4.

    King RL, Lorch SA, Cohen DM, Hodinka RL, Cohn KA, Shah SS (2007) Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger. Pediatrics 120(3):489–496

  5. 5.

    Ramers C, Billman G, Hartin M, Ho S, Sawyer MH (2000) Impact of a diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management. JAMA 283(20):2680–2685

  6. 6.

    Archimbaud C, Chambon M, Bailly JL, Petit I, Henquell C, Mirand A, Aublet-Cuvelier B, Ughetto S, Beytout J, Clavelou P, Labbe A, Philippe P, Schmidt J, Regagnon C, Traore O, Peigue-Lafeuille H (2009) Impact of rapid enterovirus molecular diagnosis on the management of infants, children, and adults with aseptic meningitis. J Med Virol 81(1):42–48

  7. 7.

    Leber AL, Everhart K, Balada-Llasat JM, Cullison J, Daly J, Holt S, Lephart P, Salimnia H, Schreckenberger PC, DesJarlais S, Reed SL, Chapin KC, LeBlanc L, Johnson JK, Soliven NL, Carroll KC, Miller JA, Dien Bard J, Mestas J, Bankowski M, Enomoto T, Hemmert AC, Bourzac KM (2016) Multicenter evaluation of BioFire FilmArray meningitis/encephalitis panel for detection of Bacteria, viruses, and yeast in cerebrospinal fluid specimens. J Clin Microbiol 54(9):2251–2261

  8. 8.

    Giulieri SG, Chapuis-Taillard C, Manuel O, Hugli O, Pinget C, Wasserfallen JB, Sahli R, Jaton K, Marchetti O, Meylan P (2015) Rapid detection of enterovirus in cerebrospinal fluid by a fully-automated PCR assay is associated with improved management of aseptic meningitis in adult patients. J Clin Virol 62:58–62

  9. 9.

    Panuganti SKN, S. (2018) Acute bacterial meningitis beyond the neonatal period. In: Long SSP, C. G.; Fischer, M. (ed) Principles and Practice of Pediatric Infectious Diseases. Elsevier, pp 278-287.e272

  10. 10.

    Thomson J, Sucharew H, Cruz AT, Nigrovic LE, Freedman SB, Garro AC, Balamuth F, Mistry RD, Arms JL, Ishimine PT, Kulik DM, Neuman MI, Shah SS, Pediatric Emergency Medicine Collaborative Research Committee HSVSG (2018) Cerebrospinal fluid reference values for young infants undergoing lumbar puncture. Pediatrics 141(3):e20173405

  11. 11.

    Kestenbaum LA, Ebberson J, Zorc JJ, Hodinka RL, Shah SS (2010) Defining cerebrospinal fluid white blood cell count reference values in neonates and young infants. Pediatrics 125(2):257–264

  12. 12.

    Semret M, Schiller I, Jardin BA, Frenette C, Loo VG, Papenburg J, McNeil SA, Dendukuri N (2017) Multiplex respiratory virus testing for antimicrobial stewardship: a prospective assessment of antimicrobial use and clinical outcomes among hospitalized adults. J Infect Dis 216(8):936–944

  13. 13.

    AlGhounaim M, Xiao Y, Caya C, Papenburg J (2017) Diagnostic yield and clinical impact of routine cell culture for respiratory viruses among children with a negative multiplex RT-PCR result. J Clin Virol 94:107–109

  14. 14.

    Biondi EA, McCulloh R, Staggs VS, Garber M, Hall M, Arana J, Barsotti B, Natt BC, Schroeder AR, Schroeder L, Wylie T, Ralston SL (2019) Reducing variability in the infant sepsis evaluation (REVISE): a National Quality Initiative. Pediatrics 144(3)

  15. 15.

    McCulloh RJ, Fouquet SD, Herigon J, Biondi EA, Kennedy B, Kerns E, DePorre A, Markham JL, Chan YR, Nelson K, Newland JG (2018) Development and implementation of a mobile device-based pediatric electronic decision support tool as part of a national practice standardization project. J Am Med Inform Assoc 25(9):1175–1182

  16. 16.

    Byington CL, Reynolds CC, Korgenski K, Sheng X, Valentine KJ, Nelson RE, Daly JA, Osguthorpe RJ, James B, Savitz L, Pavia AT, Clark EB (2012) Costs and infant outcomes after implementation of a care process model for febrile infants. Pediatrics 130(1):e16–e24

  17. 17.

    Timurkan MO, Aydin H, Sait A (2019) Identification and molecular characterisation of bovine parainfluenza virus-3 and bovine respiratory syncytial virus - first report from Turkey. J 63(2):167–173

  18. 18.

    Otto MP, Toyer AL, Poggi C, Janvier F (2019) Influenza B false-positive results by rapid molecular tests AlereTM i influenza a&B 2 in France. Diagn Microbiol Infect Dis 94(4):342–343

  19. 19.

    Robinson CC, Willis M, Meagher A, Gieseker KE, Rotbart H, Glode MP (2002) Impact of rapid polymerase chain reaction results on management of pediatric patients with enteroviral meningitis. Pediatr Infect Dis J 21(4):283–286

  20. 20.

    Aronson PL, Lyons TW, Cruz AT, Freedman SB, Okada PJ, Fleming AH, Arms JL, Thompson AD, Schmidt SM, Louie J, Alfonzo MJ, Monuteaux MC, Nigrovic LE, Pediatric Emergency Medicine Clinical Research Network Herpes Simplex Virus Study G (2017) Impact of enteroviral polymerase chain reaction testing on length of stay for infants 60 days old or younger. J Pediatr 189(169–174):e162

  21. 21.

    Nigrovic LE, Chiang VW (2000) Cost analysis of enteroviral polymerase chain reaction in infants with fever and cerebrospinal fluid pleocytosis. Arch Pediatr Adolesc Med 154(8):817–821

  22. 22.

    Basmaci R, Mariani P, Delacroix G, Azib S, Faye A, Taha MK, Bingen E, Bonacorsi S, Romero JR, Rotbart HA, Nyquist AC, Nolte FS (2011) Enteroviral meningitis does not exclude concurrent bacterial meningitis. J Clin Microbiol 49(9):3442–3443

  23. 23.

    Asner SA, Petrich A, Hamid JS, Mertz D, Richardson SE, Smieja M (2014) Clinical severity of rhinovirus/enterovirus compared to other respiratory viruses in children. Influenza Other Respir Viruses 8(4):436–442

Download references

Author information

Correspondence to Jesse Papenburg.

Ethics declarations

This study was approved by the McGill University Health Centre research ethics board (2018–4190).

Conflict of interest

J.P. has received consulting/honoraria fees or research grant funding outside of the current work from the following: AbbVie; BD Diagnostics; Cepheid; MedImmune; Hoffmann-La Roche; Jannsen Pharmaceutical; Seegene. C.C. has received honoraria fees outside of the current work from Roche Diagnostics Canada. C.P.Y. has received in-kind support for investigator-initiated research projects from bioMérieux and BD Diagnostics in the last 3 years. The remaining authors declare no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Alghounaim, M., Caya, C., Cho, M. et al. Impact of decreasing cerebrospinal fluid enterovirus PCR turnaround time on costs and management of children with suspected enterovirus meningitis. Eur J Clin Microbiol Infect Dis (2020). https://doi.org/10.1007/s10096-019-03799-2

Download citation

Keywords

  • Molecular diagnostic techniques
  • Central nervous system
  • Economic evaluation
  • Simulated cohort
  • Pleocytosis
  • Infant
  • Newborn