A host of bacteria and viruses can cause meningitis or encephalitis (ME) in the pediatric population. While viral ME in most cases resolves without specific intervention, bacterial ME has a high morbidity without appropriate treatment and can cause life-long central nervous system (CNS) sequelae. Thus, precautionary empiric antimicrobial therapy is routinely prescribed when ME is suspected. However, in children, antimicrobial agents are often unnecessary as viruses are the most common etiologic agents of meningitis [1]. Exposure to antimicrobial treatment is associated with increased risk of patient adverse effects and contributes to development of resistance.

Viral ME is generally self-limiting and requires only symptom management. Human enterovirus (HEV) is the most common cause of viral meningitis, and human parechoviruses (HPeV) have proven to be important pathogens associated with viral meningitis in children [2]. Rapid diagnosis of HEV and HPeV ME may allow for prompt discontinuation of empiric antibiotic and herpetic antiviral therapy, and hospital length of stay (LOS) may be decreased with the exclusion of bacterial etiologies [3], [4]. However, dependency on culture for off-target pathogens may limit the utility of these rapid PCR diagnostics [5].

In this retrospective analysis, we sought to determine the clinical utility of a rapid, syndromic ME panel in children diagnosed with viral ME caused by HEV/HPeV. We analyzed differences in antibiotic therapy duration, time on antivirals, and LOS between HEV/HPeV ME patients diagnosed by ME panel compared to previous standard of care methodologies, including standalone HEV/HPeV polymerase chain reaction (PCR).