Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. May 9, 2022; 11(3): 289-294
Published online May 9, 2022. doi: 10.5409/wjcp.v11.i3.289
Turnaround times for molecular testing of pediatric viral cerebrospinal fluid samples in United Kingdom laboratories
Siba Prosad Paul, Varathagini Balakumar, Arangan Kirubakaran, Jothilingam Niharika, Paul Anthony Heaton, Paul Christopher Turner
Siba Prosad Paul, Paul Anthony Heaton, Department of Paediatrics, Yeovil District Hospital, Yeovil BA21 4AT, Somerset, United Kingdom
Varathagini Balakumar, Jothilingam Niharika, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
Arangan Kirubakaran, Department of Paediatrics, Hillingdon Hospital, Uxbridge UB8 3NN, United Kingdom
Paul Christopher Turner, Department of Medical Microbiology, Torbay Hospital, Torquay TQ2 7AA, United Kingdom
Author contributions: Paul SP contributed to the Project concept, formulation of questionnaire survey, supervision, data analysis, manuscript revision, literature review and correspondence; Balakumar V, Kirubakaran A and Niharika J conducted interviews, data collection and analysis, prepared first draft; Heaton PA and Turner PC provided expert opinion, helped with formulation of questionnaire survey, edited manuscript.
Institutional review board statement: This is a national questionnaire survey and ethical approval wasn't considered necessary.
Conflict-of-interest statement: None for any of the authors.
Data sharing statement: All data has been included in the paper.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Siba Prosad Paul, MBBS, DCH, MRCPCH, Consultant Paediatrician, Department of Paediatrics, Yeovil District Hospital, Higher Kingston, Yeovil BA21 4AT, Somerset, United Kingdom. siba.paul@nhs.net
Received: June 21, 2021
Peer-review started: June 21, 2021
First decision: July 30, 2021
Revised: August 1, 2021
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: May 9, 2022
Processing time: 319 Days and 14.3 Hours
Abstract
BACKGROUND

Rapid molecular testing has revolutionized the management of suspected viral meningitis and encephalitis by providing an etiological diagnosis in < 90 min with potential to improve outcomes and shorten inpatient stays. However, use of molecular assays can vary widely.

AIM

To evaluate current practice for molecular testing of pediatric cerebrospinal fluid (CSF) samples across the United Kingdom using a structured questionnaire.

METHODS

A structured telephone questionnaire survey was conducted between July and August 2020. Data was collected on the availability of viral CSF nucleic acid amplification testing (NAAT), criteria used for testing and turnaround times including the impact of the coronavirus disease 2019 pandemic.

RESULTS

Of 196/212 (92%) microbiology laboratories responded; 63/196 (32%) were excluded from final analysis as they had no on-site microbiology laboratory and outsourced their samples. Of 133 Laboratories included in the study, 47/133 (35%) had onsite facilities for viral CSF NAAT. Hospitals currently undertaking onsite NAAT (n = 47) had much faster turnaround times with 39 centers (83%) providing results in ≤ 24 h as compared to those referring samples to neighboring laboratories (5/86; 6%).

CONCLUSION

Onsite/near-patient rapid NAAT (including polymerase chain reaction) is recommended wherever possible to optimize patient management in the acute setting.

Keywords: Cerebrospinal fluid, Nucleic acid amplification testing, Questionnaire survey, Turnaround times, Viral studies

Core Tip: Rapid diagnosis of viral meningitis in children through nucleic acid amplification testing (NAAT) of cerebrospinal fluid (CSF) can help in establishing a firm diagnosis, allowing early discontinuation of antibiotics and ensuring improved antibiotic stewardship. Turnaround times will be improved through availability of onsite NAAT facilities in the hospitals with inpatient pediatric units. All CSF samples in infants, irrespective of their white cell counts (actual/adjusted) should be offered NAAT, as viral meningitis due to enterovirus or human parechovirus can occur without pleocytosis.