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The impact of cerebrospinal fluid viral polymerase chain reaction testing on the management of adults with viral meningitis: a multi-centre retrospective study.

AIM
The aim of this study was to evaluate the role of viral polymerase chain reaction (PCR) testing in patients with aseptic meningitis and identify opportunities for improvement in clinical management.


METHODS
All cerebrospinal fluid samples collected in one year from four teaching hospitals in Sydney, Australia, were reviewed. Patients with aseptic meningitis were selected, and clinical and diagnostic features, hospital length of stay (LOS) and treatment were analysed.


RESULTS
Identifying a cause by viral PCR did not reduce hospital LOS (median 3 days) or antibiotic use (median 2 days), but the turnaround time of the PCR test correlated with LOS (Rs=0.3822, P= 0.0003). Forty-one percent of patients received intravenous acyclovir treatment, which was more frequent in patients admitted under neurologists than infectious diseases physicians (56 vs 24%; P=0.013). The majority of patients did not have investigations for alternative causes of aseptic meningitis such as HIV and syphilis if the viral PCR panel was negative.


CONCLUSION
The benefit of PCR testing in aseptic meningitis in adults in reducing LOS and antibiotic use is unclear. The reasons for unnecessary aciclovir use in meningitis syndromes requires further assessment. This article is protected by copyright. All rights reserved.