Enteroviruses (EVs) are important pediatric pathogens responsible for 10-15 million symptomatic infections/year in the U.S. Reverse transcription-polymerase chain reaction (RT-PCR) detection of the EV provides extremely rapid diagnosis and offers the potential for improved patient care. Multiple studies have predicted the potential clinical utility of RT-PCR detection of the EV. While promising, RT-PCR has not yet been shown to modify the management of EV infected children or reduce patient care cost.

We conducted an IRB approved prospective study of the impact of RT-PCR diagnosis of EV infections on the care of febrile children. From 6.1-10.31.97, a non-commercial RT-PCR assay for the detection of EV in CSF was offered as part of the laboratory evaluation of hospitalized febrile children. The assay was performed in 8 hs and results were reported directly to the requesting physician. CSF was also cultured for EV. Specimens from 66 patients, ages 2 days-16 years, were submitted for evaluation. EV was detected by RT-PCR in 23 patients (34.8%) and by culture in 17 of 60 (28.3%). The mean time to positive culture was 4.5 days. Antibiotics were administered for a mean of 1.5 days in EV RT-PCR positive children and 2.8 days in the RT-PCR negative group. The mean duration of hospitalization of febrile children positive for EV by RT-PCR, compared to the negative group, was 41 hs vs. 75 hs, respectively. Time to discharge of patients positive for EV by RT-PCR, after physician notification, was ≤4 hs in 47%, 16-24 hs in 43%, and 39-44 hs in 10%.

This study documents decreased antibiotic administration and length of hospitalization in febrile children diagnosed via RT-PCR as having EV infections. It validates previous reports predicting similar findings. Delays observed in discharge of EV positive patients may be decreased by educational efforts to inform physicians about this assay and the natural history of EV infections. The potential yearly national cost savings through reduced days of hospitalization and antibiotic usage afforded by such an assay, if widely available, would be considerable.