James T Gaensbauer1, Meghan Birkholz2, Kari Pfannenstein2, James K Todd3. 1. Divison of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and james.gaensbauer@childrenscolorado.org. 2. Department of Epidemiology, Children's Hospital Colorado, Aurora, Colorado. 3. Divison of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and Department of Epidemiology, Children's Hospital Colorado, Aurora, Colorado.
Abstract
BACKGROUND: Diagnostic strategies based on empirical testing and treatment to identify herpes simplex virus (HSV) infection in neonates may not be appropriate for older children in whom the most common presentation of severe infection is encephalitis, a rare and clinically recognizable condition. METHODS: Use of acyclovir in infants and children in 6 common non-HSV infection-related diagnosis-related groups was characterized between 1999 and 2012 at 15 US pediatric hospitals by using the Pediatric Health Information System database. Characteristics of non-neonatal patients at 1 institution tested for HSV encephalitis over a 6.5-year period were then analyzed to identify factors associated with potentially unnecessary testing and treatment. RESULTS: Acyclovir use increased from 7.6% to 15.6% (P < .001) from 1999 to 2012. Much of this increase came in infants 30 to 60 days of age (82.7% increase, P < .001) and in patients with milder disease severity (44.8% increase, P < .001). Length of stay was increased by 2 days for children treated with acyclovir (P < .001). At our institution, 1394 HSV cerebrospinal fluid polymerase chain reactions were performed in children >30 days old, with only 3 positive results (0.22%). Comparison of the 3 subjects with positive testing and 55 with negative testing revealed that all cases, but only 4% (95% confidence interval 1.2%-14.0%) of noncases had clinical characteristics typical of HSV encephalitis. CONCLUSIONS: Strategies for diagnosis and empirical treatment of suspected HSV encephalitis beyond the neonatal period have trended toward the approach common for neonates without evidence of an increase in disease incidence. This may result in increased medical costs and risk to patients.
BACKGROUND: Diagnostic strategies based on empirical testing and treatment to identify herpes simplex virus (HSV) infection in neonates may not be appropriate for older children in whom the most common presentation of severe infection is encephalitis, a rare and clinically recognizable condition. METHODS: Use of acyclovir in infants and children in 6 common non-HSV infection-related diagnosis-related groups was characterized between 1999 and 2012 at 15 US pediatric hospitals by using the Pediatric Health Information System database. Characteristics of non-neonatal patients at 1 institution tested for HSV encephalitis over a 6.5-year period were then analyzed to identify factors associated with potentially unnecessary testing and treatment. RESULTS:Acyclovir use increased from 7.6% to 15.6% (P < .001) from 1999 to 2012. Much of this increase came in infants 30 to 60 days of age (82.7% increase, P < .001) and in patients with milder disease severity (44.8% increase, P < .001). Length of stay was increased by 2 days for children treated with acyclovir (P < .001). At our institution, 1394 HSV cerebrospinal fluid polymerase chain reactions were performed in children >30 days old, with only 3 positive results (0.22%). Comparison of the 3 subjects with positive testing and 55 with negative testing revealed that all cases, but only 4% (95% confidence interval 1.2%-14.0%) of noncases had clinical characteristics typical of HSV encephalitis. CONCLUSIONS: Strategies for diagnosis and empirical treatment of suspected HSV encephalitis beyond the neonatal period have trended toward the approach common for neonates without evidence of an increase in disease incidence. This may result in increased medical costs and risk to patients.
Authors: Kevin Messacar; James T Gaensbauer; Meghan Birkholz; Claire Palmer; James K Todd; Kenneth L Tyler; Samuel R Dominguez Journal: Diagn Microbiol Infect Dis Date: 2020-05-17 Impact factor: 2.803
Authors: Andrea T Cruz; Stephen B Freedman; Dina M Kulik; Pamela J Okada; Alesia H Fleming; Rakesh D Mistry; Joanna E Thomson; David Schnadower; Joseph L Arms; Prashant Mahajan; Aris C Garro; Christopher M Pruitt; Fran Balamuth; Neil G Uspal; Paul L Aronson; Todd W Lyons; Amy D Thompson; Sarah J Curtis; Paul T Ishimine; Suzanne M Schmidt; Stuart A Bradin; Kendra L Grether-Jones; Aaron S Miller; Jeffrey Louie; Samir S Shah; Lise E Nigrovic Journal: Pediatrics Date: 2018-01-03 Impact factor: 7.124
Authors: Dara Petel; Michelle Barton; Christian Renaud; Lynda Ouchenir; Jason Brophy; Jennifer Bowes; Sarah Khan; Ari Bitnun; Jane McDonald; Andrée-Anne Boisvert; Joseph Ting; Ashley Roberts; Joan L Robinson Journal: BMC Pediatr Date: 2020-05-26 Impact factor: 2.125
Authors: Madison Clague; Carla Kim; Jason Zucker; Daniel A Green; Yifei Sun; Susan Whittier; Kiran T Thakur Journal: Open Forum Infect Dis Date: 2022-07-22 Impact factor: 4.423