suboptimal management of central nervous system infections in children a multi-centre retrospective study次优儿童中枢神经系统感染的管理进行的多中心回顾性研究.pdf

Kelly et al. BMC Pediatrics 2012, 12:145 /1471-2431/12/145 RESEARCH ARTICLE Open Access Suboptimal management of central nervous system infections in children: a multi-centre retrospective study 1 2 3,4 5 4,6 7,8* Christine Kelly , Aman Sohal , Benedict D Michael , Andrew Riordan , Tom Solomon and Rachel Kneen Northwest Neurological Infections Network Abstract Objective: We aimed to audit the regional management of central nervous system (CNS) infection in children. Methods: 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. Results: 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 h