In temperate climates, enteroviruses (EV) are the most common cause of vernal cases of meningitis and fever without an identifiable focus. In infants and children, management typically includes hospitalization and empiric use of antibiotics for 48-72 hours until cerebrospinal fluid (CSF), blood, and urine cultures (Cx) are reported as negative or less if EV is found by CSF Cx. Polymerase chain reaction (PCR) provides a means for rapid diagnosis of EV meningitis and may help decrease hospital stay.

A retrospective study to assess potential health care cost savings and determine optimum reporting time for PCR EV detection was conducted. From 6/24 to 9/30 1995 all residual CSF samples were collected and stored frozen until tested using a commercial EV PCR assay (Amplicor, Roche Molecular Systems). Records of patients with EV positive CSF were reviewed and information regarding patient profile, hospital course, and antibiotic use was extracted. EV genome was detected in the CSF of 21 of 140 (15%) patients. The median age was 2 months (range 4 days-18 yrs). Four patients had only ER encounters, 17 were hospitalized (mean stay: 2.9 days). Empiric antibiotic therapy was initiated in 95% of hospitalized patients (mean duration 2.9 days). In 38%(8/21) CSF viral Cx was done. Six were positive for EV. Range of time to positive Cx was 2-4 days. Based on each patient's clinical course and had PCR results been reported by the end of the first fully staffed microbiology shift after CSF was obtained, the predicted mean length of hospitalization would have decreased to 1.5 days. A mean of 1.8 days/patient of antibiotic therapy would have been eliminated. Based on local billing practices an average cost savings of at least $500/patient would be predicted. Further delay in reporting PCR results would adversely impact length of stay and cost savings.

Rapid EV diagnosis using PCR could significantly shorten hospitalization of children with EV infection, resulting in significant annual health care cost savings. Laboratories proposing to use PCR for the diagnosis of EV infections must provide the shortest possible reporting interval. In part, funded by Roche Molecular Systems, Somerville, NJ.