Suboptimal management of central nervous system infections in children: a multi-centre retrospective study
1 Neurological Infectious Disease, Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
2 Paediatric Neurology Registrar, Littlewood Neurosciences Unit, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool, UK
3 NIHR Doctoral Research Registrar Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
4 Division of Neurological Science, Walton Neuro-Centre NHS Foundation Trust, Liverpool, UK
5 Paediatric Infectious Diseases Department of Infectious Diseases, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool, UK
6 Director, Institute for Infection and Global Health, University of Liverpool, Liverpool, UK
7 Paediatric Neurologist and Honorary Clinical Lecturer Littlewoods Neuroscience Unit, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool, L12 2AP, UK
8 Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
BMC Pediatrics 2012, 12:145 doi:10.1186/1471-2431-12-145Published: 7 September 2012
We aimed to audit the regional management of central nervous system (CNS) infection in children.
The study was undertaken in five district general hospitals and one tertiary paediatric hospital in the Mersey region of the UK. Children admitted to hospital with a suspected CNS infection over a three month period were identified. Children were aged between 4 weeks and 16 years old. Details were recorded from the case notes and electronic records. We measured the appropriateness of management pathways as outlined by national and local guidelines.
Sixty-five children were identified with a median age of 6 months (range 1 month to 15 years). Ten had a CNS infection: 4 aseptic meningitis, 3 purulent meningitis, 3 encephalitis [2 with herpes simplex virus (HSV) type 1]. A lumbar puncture (LP) was attempted in 50 (77%) cases but only 43 had cerebrospinal fluid (CSF) available for analysis. Of these 24 (57%) had a complete standard set of tests performed. Fifty eight (89%) received a third generation cephalosporin. Seventeen (26%) also received aciclovir with no obvious indication in 9 (53%). Only 11 (65%) of those receiving aciclovir had CSF herpes virus PCR. Seventeen had cranial imaging and it was the first management step in 14. Treatment lengths of both antibiotics and aciclovir were highly variable: one child with HSV encephalitis was only treated with aciclovir for 7 days.
The clinical management of children with suspected CNS infections across the Mersey region is heterogeneous and often sub-optimal, particularly for the investigation and treatment of viral encephalitis. National guidelines for the management of viral encephalitis are needed.