Improvement of the Management of Infants, Children and Adults with a Molecular Diagnosis of Enterovirus Meningitis during Two Observational Study Periods

<div><p>Enteroviruses (EVs) are a major cause of aseptic meningitis, and RNA detection using molecular assay is the gold standard diagnostic test. The aim of this study was to assess the impact of an EV positive diagnosis on the clinical management of patients admitted for meningitis over the course of two observational study periods (2005 and 2008–09) in the same clinical departments. We further investigated in multivariate analysis various factors possibly associated with hospital length of stay (LOS) in all age groups (infants, children, and adults). The results showed an overall improvement in the management of patients (n = 142) between the study periods, resulting in a significantly shorter hospital LOS for adults and children, and a shorter duration of antibiotic use for adults and infants. In multivariate analysis, we observed that the time from molecular test results to discharge of patients and the median duration of antibiotic treatment were associated with an increase in LOS in all age groups. In addition, among adults, the turnaround time of the molecular assay was significantly correlated with LOS. The use of CT scan in children and hospital admission outside the peak of EV prevalence in infants tended to increase LOS. In conclusion, the shorter length of stay of patients with meningitis in this study was due to various factors including the rapidity of the EV molecular test (particularly in adults), greater physician responsiveness after a positive result (in adults and children), and greater experience on the part of physicians in handling EV meningitis, as evidenced by the shorter duration of antibiotic use in adults and infants.</p></div

Univariate and multivariate analysis of factors associated with hospital length of stay in children (n = 68) with enterovirus (EV) meningitis during the two study periods (2005–2008–09).

a<p>Data show an adjusted hazard ratio (HR) with 95% CI through a simple and multiple Cox regression model. with HR over 1 denoting a decrease in LOS.</p><p>Abbreviations: CI. confidence interval; IQR. interquartile range. The enterovirus season was defined as May 1 through October 31 for each study period.</p

Univariate and multivariate analysis of factors associated with hospital length of stay in adults (n = 49) with enterovirus (EV) meningitis during the two study periods (2005–2008–09).

a<p>Data show an adjusted hazard ratio (HR) with 95% CI through a simple and multiple Cox regression model. with HR over 1 denoting a decrease in LOS.</p><p>Abbreviations: CI. confidence interval; IQR. interquartile range. The enterovirus season was defined as May 1 through October 31 for each study period.</p

Comparison of time parameters and service use in infants, children, and adults with enterovirus meningitis in 2008–09 with those of a previous observational study in 2005^a.

a<p>Reference study <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0068571#pone.0068571-Archimbaud1" target="_blank">[3]</a>.</p>b<p>Only the patients (infants. children. and adults) admitted to hospital between Sunday 10 a.m. and Friday 10 a.m. were included (n = 98).</p>*<p>i.e. time from event 1 to event 2 = event 2 - event 1, negative values meaning event 2 occurred before event 1.</p><p>e.g. time from results to discharge equal to −0.3 hr means that results were available 0.3 h after patients’ discharge.</p