Herpes PCR Testing and Empiric Acyclovir Use Beyond the Neonatal Period
Herpes PCR Testing and Empiric Acyclovir Use Beyond the Neonatal Period
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DOI：
10.1542/peds.2014-0294
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发表时间：
2014-09-01
期刊：
影响因子：
8
通讯作者：
Todd, James K.
中科院分区：
文献类型：
--
作者：
Gaensbauer, James T.;Birkholz, Meghan;Todd, James K.
背景：基于经验检测和治疗来确定新生儿单纯疱疹病毒（HSV）感染的诊断策略可能不适合年龄较大的儿童，因为年龄较大的儿童最常见的严重感染表现是脑炎，这是一种罕见的临床可识别的疾病。方法：通过使用儿科健康信息系统数据库，对1999年至2012年间美国15家儿科医院6个常见非hsv感染相关诊断相关组的婴儿和儿童使用阿昔洛韦的情况进行分析。然后分析1家机构的非新生儿患者在6.5年期间检测HSV脑炎的特征，以确定与潜在不必要的检测和治疗相关的因素。结果：阿昔洛韦的使用率从1999年的7.6%上升到2012年的15.6% （P < 0.001）。这种增加主要发生在30至60天的婴儿（增加82.7%,P < .001）和病情较轻的患者（增加44.8%,P < .001）。阿昔洛韦治疗组患儿住院时间延长2天（P < 0.001）。在我院，1394例bb ~ 30日龄儿童进行HSV脑脊液聚合酶链反应，阳性结果仅3例（0.22%）。3例阳性者和55例阴性者的比较显示，所有病例均具有典型的HSV脑炎临床特征，但只有4%（95%可信区间为1.2% ~ 14.0%）的非病例具有典型的HSV脑炎临床特征。结论：新生儿期后疑似HSV脑炎的诊断和经验性治疗策略趋向于新生儿常见的方法，没有证据表明疾病发病率增加。这可能会增加患者的医疗费用和风险。
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.