Richard L Hodinka

University of Pennsylvania, Philadelphia, Pennsylvania, United States

Are you Richard L Hodinka?

Claim your profile

Publications (85)303.78 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Allogeneic hematopoietic stem cell transplantation (SCT) is often used as definitive therapy for hemophagocytic lymphohistiocytosis (HLH). Data on infectious complications in post-SCT HLH patients are limited, with no analyses comparing their infectious risk to other SCT recipients. This study compares post-SCT infection frequency and mortality rates between pediatric HLH and leukemia patients. Methods: All HLH SCT patients from 1997 to 2009 were identified from the bone marrow registry at The Children's Hospital of Philadelphia. HLH patients were matched one-to-one to leukemia SCT patients by age and transplant year. Data on demographics, donor source, conditioning regimens, microbiologically-proven infections, and vital status 6 months post-SCT were collected. Multivariate conditional Poisson and logistic/Cox regression models compared infection rate per follow-up days and mortality, respectively. Results: Eighteen HLH SCT patients (100%) had at least one infection, (median: 2; IQR: 1 to 4). Half of the leukemia SCT recipients had at least 1 infection (median: 1; IQR: 0 to 2). Compared to leukemia patients, HLH patients had a greater incidence of total infections (IRR: 2.47, 95% CI: 1.01 to 6.05; Table 1). After adjusting for sex, conditioning regimen, and antithymocyte or antilymphocyte globulin (ATG/ALG) use, this difference was no longer significant (IRR: 1.69, 95% CI: 0.72 to 3.95). Receipt of ATG/ALG was independently associated with a greater infection rate (IRR: 2.30, 95% CI: 1.10 to 4.81). Mortality rate (HLH 22%, leukemia 28%) and time to death post-SCT did not differ between groups. Conclusion: HLH SCT recipients have a higher infection rate in the 6 months post-HSCT compared to leukemia patients, a factor associated with pre-transplant ATG/ALG use. It is possible a difference in mortality and infection rates exists beyond the variation in ATG/ALG exposure. Further study of larger cohorts is needed. Table 1. Microbiologically Proven Infection HLH Leukemia n (%) Bacteremia Gram Positive 14 (42) 5 (35) Gram Negative 2 (6) 6 (42) Candidemia 2 (6) 0 Viral Respiratory 9 (27) 2 (14) Reactivation 6 (18) 1 (7)
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Adenovirus (HAdV) infections are associated with significant morbidity and mortality in pediatric hematopoietic stem cell transplant (HSCT) recipients. Serial HAdV polymerase chain reaction (PCR) testing is sometimes used to identify adenoviremia with a goal of early intervention. It is laborious and costly to serially test all HSCT recipients. We aimed to derive a prediction rule using data available at the time of HSCT to identify those who did and did not develop adenoviremia. An accurate prediction model could allow for more focused HAdV testing. Methods: We retrospectively identified 126 pediatric patients that: (1) received HSCT at The Children’s Hospital of Philadelphia between 2006 and 2012; and, (2) underwent surveillance HAdV PCR testing. Using stochastic gradient boosting (SGB) methodology we derived a prediction model to discriminate between those patients who did and did not develop adenoviremia in a 6-month post transplant period. To establish a balanced dataset, adenoviremic patients were compared to randomly selected controls. The model was repeated 100 times to achieve an average confusion matrix. Predictors included age, race, gender, previous HSCT, indication for HSCT, allogeneic vs. autologous HSCT, match status, stem cell source, T-cell depletion, receipt of conditioning, total body irradiation and presence of chronic comorbid conditions at time of HSCT. Results: Twenty-nine (23%) patients developed adenoviremia; median time to adenoviremia was 37 days (IQR: 20 to 69 days). No single baseline characteristic accurately discriminated those with and without adenoviremia. The best-fit SGB predictive model had a sensitivity of 75% (95% CI: 0.55 – 0.88) and specificity of 77% (95% CI: 0.57 – 0.90). The false positive and negative rates were 0.23 (95% CI: 0.10 – 0.43) and 0.25 (95% CI: 0.11 – 0.44), respectively with an average out of bag error of 0.21. Conclusion: PCR surveillance testing in pediatric HSCT recipients commonly identified adenoviremia. The derived model for predicting adenoviremia had reasonable sensitivity, specificity and out of bag error. Refining the model to include additional baseline variables such as specific conditioning medications and more adenoviremia events is necessary to reduce the false positive and false negative rates.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 08/2013; · 3.12 Impact Factor
  • Ana María Cárdenas, Eleonore Baughan, Richard L. Hodinka
    [Show abstract] [Hide abstract]
    ABSTRACT: Background In the United States, a new HIV diagnostic algorithm has been proposed that uses an HIV-1/HIV-2 antibody differentiation immunoassay instead of Western blot or immunofluoresence for confirmatory testing. Objectives To evaluate the Multispot HIV-1/HIV-2 Rapid Test (Multispot) as an alternative to Western blot analysis for confirmation of HIV infection. Study Design A series of 205 serum and plasma specimens positive for HIV-1 or HIV-2 were used to compare the performance of Multispot to a standard HIV-1 Western blot. Positive samples included 63 specimens from patients >18 months of age, 33 proficiency survey specimens, and 109 specimens from nine commercial seroconversion and performance panels. In addition, 63 specimens from 51 HIV-exposed, uninfected children ≤18 months of age in various stages of seroreversion and 192 HIV-negative samples were tested. Specimens were initially screened using a 4th generation HIV Ag/Ab Combo assay. Results Multispot readily discriminated between individuals with HIV-1 or HIV-2 infection and those who were uninfected. Of the 205 samples repeatedly reactive by the 4th generation screening assay, infection status was correctly confirmed by Multispot in 83.9% (172/205) compared to 68.8% (141/205) for Western blot. Multispot detected HIV-1 earlier in 27.6% of low-titer antibody specimens called indeterminate by Western blot, and effectively reduced the number of indeterminate results in seroreverting HIV-1 exposed, uninfected infants and for HIV-2 infections misinterpreted as indeterminate or positive by HIV-1 Western blot. Conclusions Multispot offers speed and simplicity over Western blot and has an excellent performance for differentiation and confirmation of antibodies to HIV-1 and HIV-2.
    Journal of Clinical Virology 08/2013; · 3.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A 15-year-old previously healthy male presented with fever, vomiting, diarrhea, malaise, and altered mental status. In the emergency department, the patient appeared acutely ill, was febrile, tachycardic, hypotensive, and slow to respond to commands. He was quickly transferred to the ICU where initial evaluation revealed elevated white blood cell count and inflammatory markers, coagulopathy, abnormal liver function, and renal failure. Head computed tomography, cerebrospinal fluid studies, and blood cultures were negative. He was quickly stabilized with intravenous fluids and broad-spectrum antibiotics. When his mental status improved, the patient consented to HIV testing and was found to be negative using laboratory-based and rapid third-generation HIV type 1 (HIV-1)/HIV type 2 antibody assays. The specimen was subsequently shown to be positive for HIV by a newly licensed fourth-generation antigen/antibody test. HIV-1 Western blot performed on this sample was negative, but molecular testing for HIV-1 RNA 4 days later was positive and confirmed the screening result. The patient was later determined to have a viral load of 5 624 053 copies/mL and subsequently admitted to unprotected receptive anal intercourse 2 weeks before admission. This case demonstrates an atypically severe presentation of acute HIV infection with important lessons for pediatricians. It highlights the need to consider acute HIV infection in the differential diagnosis of the critically ill adolescent and for appropriate testing if acute infection is suspected. This case also illustrates the shortcomings of testing adolescents based only on reported risk and supports Centers for Disease Control and Prevention and American Academy of Pediatrics recommendations for routine testing.
    PEDIATRICS 03/2013; 131(3):e959-63. · 4.47 Impact Factor
  • Source
    Richard L Hodinka, Laurent Kaiser
    [Show abstract] [Hide abstract]
    ABSTRACT: Conventional tube culture systems have long been the mainstay in clinical virology for the growth and identification of viruses from clinical specimens. Innovations such as centrifugation-enhanced shell vial and multiwell plate cultures and the use of genetically engineered and mixed cell lines coupled with a faster detection of viral replication has allowed for reasonable turn around times for even some of the most slow growing, clinically important human viruses. However, molecular methods, and in particular the polymerase chain reaction (PCR), have usurped the role of viral culture in many laboratories, limiting the use of this traditional method of virus detection or replacing it altogether. Advances and improvements in molecular technology over time have also resulted in newer generations of more rapid and accurate molecular assays for detection, quantification, and genetic characterization of viruses. In this point counterpoint, we have asked two individuals, Richard L. Hodinka of the Children's Hospital of Philadelphia, a clinical virologist whose laboratory has completely eliminated viral culture in favor of molecular methods and Laurent Kaiser, head of the Virology Laboratory at the University of Geneva Hospital, who continues to be a strong advocate for viral culture to discuss the relevance of viral culture in the molecular age.
    Journal of clinical microbiology 10/2012; · 4.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: To determine the prevalence of central nervous system (CNS) herpes simplex virus (HSV) infection in neonates evaluated in the emergency department and to identify factors associated with cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) testing. An existing testing paradigm was then applied to determine its potential impact on testing frequency. METHODS: This nested case-control study included infants aged 0 to 28 days who had lumbar puncture in the emergency department. Multivariate logistic regression was used to identify factors associated with CSF HSV PCR testing. RESULTS: The CSF HSV PCR testing was performed in 266 (47%) of 570 neonates. The prevalence of CNS HSV infection was 0.5% compared with 1.6% for bacterial meningitis. Performance of CSF HSV PCR testing was not associated with known HSV risk factors. Application of a known HSV testing paradigm would have reduced the proportion of infants tested by 21% without missing any of the cases of CNS HSV infection. CONCLUSIONS: The HSV testing remains common despite the low prevalence of HSV infection. The CSF HSV PCR testing is not well aligned with known risk factors. Future testing strategies should incorporate community HSV prevalence, known neonatal risk factors, and clinical judgment.
    Pediatric emergency care 09/2012; 28(10):949-955. · 0.92 Impact Factor
  • Source
    Virginia M Pierce, Richard L Hodinka
    [Show abstract] [Hide abstract]
    ABSTRACT: A novel eSensor respiratory viral panel (eSensor RVP) multiplexed nucleic acid amplification test (GenMark Diagnostics, Inc., Carlsbad, CA) was compared to laboratory-developed real-time PCR assays for the detection of various respiratory viruses. A total of 250 frozen archived pediatric respiratory specimens previously characterized as either negative or positive for one or more viruses by real-time PCR were examined using the eSensor RVP. Overall agreement between the eSensor RVP and corresponding real-time PCR assays for shared analytes was 99.2% (kappa = 0.96 [95% confidence interval {CI}, 0.94 to 0.98]). The combined positive percent agreement was 95.4% (95% CI, 92.5 to 97.3); the negative percent agreement was 99.7% (95% CI, 99.4 to 99.8). The mean real-time PCR threshold cycle (C(T)) value for specimens with discordant results was 39.73 (95% CI, 38.03 to 41.43). Detection of coinfections and correct identification of influenza A virus subtypes were comparable between methods. Of note, the eSensor RVP rhinovirus assay was found to be more sensitive and specific than the corresponding rhinovirus real-time PCR. In contrast, the eSensor RVP adenovirus B, C, and E assays demonstrated some cross-reactivity when tested against known adenovirus serotypes representing groups A through F. The eSensor RVP is robust and relatively easy to perform, it involves a unique biosensor technology for target detection, and its multiplexed design allows for efficient and simultaneous interrogation of a single specimen for multiple viruses. Potential drawbacks include a slower turnaround time and the need to manipulate amplified product during the protocol, increasing the possibility of contamination.
    Journal of clinical microbiology 08/2012; 50(11):3458-65. · 4.16 Impact Factor
  • Virginia M Pierce, Richard L Hodinka
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 04/2012; 54(3):203-6. · 3.12 Impact Factor
  • Virginia M Pierce, Richard L Hodinka
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 12/2011; 53(2):93-6. · 3.12 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The FilmArray Respiratory Panel (RP) multiplexed nucleic acid amplification test (Idaho Technology, Inc., Salt Lake City, UT) was compared to laboratory-developed real-time PCR assays for the detection of various respiratory viruses and certain bacterial pathogens. A total of 215 frozen archived pediatric respiratory specimens previously characterized as either negative or positive for one or more pathogens by real-time PCR were examined using the FilmArray RP system. Overall agreement between the FilmArray RP and corresponding real-time PCR assays for shared analytes was 98.6% (kappa = 0.92 [95% confidence interval (CI), 0.89 to 0.94]). The combined positive percent agreement was 89.4% (95% CI, 85.4 to 92.6); the negative percent agreement was 99.6% (95% CI, 99.2 to 99.8). The mean real-time PCR threshold cycle (C(T)) value for specimens with discordant results was 36.46 ± 4.54. Detection of coinfections and correct identification of influenza A virus subtypes were comparable to those of real-time PCR when using the FilmArray RP. The greatest comparative difference in sensitivity was observed for adenovirus; only 11 of 24 (45.8%; 95% CI, 27.9 to 64.9) clinical specimens positive for adenovirus by real-time PCR were also positive by the FilmArray RP. In addition, upon testing 20 characterized adenovirus serotypes prepared at high and low viral loads, the FilmArray RP did not detect serotypes 6 and 41 at either level and failed to detect serotypes 2, 20, 35, and 37 when viral loads were low. The FilmArray RP system is rapid and extremely user-friendly, with results available in just over 1 h with almost no labor involved. Its low throughput is a significant drawback for laboratories receiving large numbers of specimens, as only a single sample can be processed at a time with one instrument.
    Journal of clinical microbiology 11/2011; 50(2):364-71. · 4.16 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Our objective was to analyze the pathways leading to resistance of HIV to the integrase (IN) inhibitor raltegravir (RAL). Three HIV-infected individuals exhibiting RAL resistance pathway switching were characterized using longitudinal analysis of viral samples from plasma. 454/Roche pyrosequencing was used to generate approximately 74,000 sequence reads from the integrase coding region. Effects of error were controlled by denoising with Pyronoise, and by comparison to approximately 142,000 control reads from HIV(NL4-3). Viral lineages were modeled quantitatively using viral serial pathway analysis (vSPA). All three patients showed transitions from the N155H pathway to the Q148H/G140S pathway. Analysis with vSPA revealed complex pathways to the final genotype, probably involving both de-novo mutation and recombination. No reads contained both the N155H and Q148H drug resistance mutations (DRMs), indicating that the double mutant is not a prominent intermediate, consistent with low fitness. To characterize possible drug-resistant variants circulating prior to therapy, we sequenced approximately 70,000 reads from samples collected prior to initiating treatment. Although some preexisting drug-resistant variants were detected, N155H, the first major DRM present after initiating RAL therapy, was not detected. The main DRMs are present at very low levels if at all prior to initiating therapy. We also outline general methods for deep sequence analysis of DRMs in longitudinal HIV samples.
    AIDS (London, England) 08/2011; 25(16):1951-9. · 4.91 Impact Factor
  • Source
    Virginia M Pierce, Brandy Neide, Richard L Hodinka
    [Show abstract] [Hide abstract]
    ABSTRACT: The Gen-Probe Aptima HIV-1 RNA qualitative assay was evaluated as an alternative to Western blot analysis for the confirmation of HIV infection using serum samples that were repeatedly reactive for HIV antibodies. The Aptima HIV assay readily discriminated between HIV-1-infected and -uninfected individuals and effectively reduced the number of indeterminate results relative to Western blot analysis.
    Journal of clinical microbiology 02/2011; 49(4):1642-5. · 4.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND:Cerebrospinal fluid (CSF) protein values decline over the first few months of life as the infant's blood-CSF barrier matures. However, published studies differ in the reported rate, timing, and magnitude of this decline.OBJECTIVE:To quantify the age-related changes in CSF protein concentration and to determine accurate, age-specific reference values for neonates and young infants.DESIGN, SETTING AND PATIENTS:This cross-sectional study included infants age 56 days or younger who had a lumbar puncture performed in the emergency department of an urban tertiary care children's hospital between January 1, 2005 and June 30, 2007. Infants with conditions associated with elevated CSF protein concentrations, including traumatic lumbar puncture and bacterial or viral meningitis, were excluded.RESULTS:Of 1064 infants undergoing lumbar puncture, 375 (35%) met inclusion criteria. The median CSF protein value was 58 mg/dL (interquartile range: 48–72 mg/dL). In linear regression, the CSF protein concentration decreased 6.8% (95% confidence interval [CI], 5.4%-8.1%; P < 0.001) with each 1 week increase in age. The 95th percentile values were 115 mg/dL for infants ≤28 days and 89 mg/dL for infants 29–56 days. The 95th percentile values by age category were as follows: ages 0–14 days, 132 mg/dL; ages 15–28 days, 100 mg/dL; ages 29–42 days, 89 mg/dL; and ages 43–56 days, 83 mg/dL.CONCLUSIONS:We quantify the age-related decline in CSF protein concentration among infants 56 days of age and younger and provide age-specific reference values. The values reported here represent the largest series to-date for this age group. Journal of Hospital Medicine 2011. © 2010 Society of Hospital Medicine.
    Journal of Hospital Medicine 12/2010; 6(1):22 - 27. · 1.40 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The use of corticosteroids and other immunosuppressive agents increases the risk of infection in patients with systemic lupus erythematosus (SLE). The role of human adenoviruses (HAdV) in the etiology of acute viral diseases in these patients is not known. Describe a case of acute fatal disseminated adenovirus infection in an SLE patient receiving immunosuppressive therapy. Case report and detailed viral diagnosis by real time PCR and molecular typing of virus isolates by sequencing of hexon and fiber genes and restriction enzyme analysis of viral DNA. HAdV was detected by real time PCR in multiple clinical specimens including respiratory, urine, plasma, synovial fluid, and cerebrospinal fluid. Amplification and sequence analysis of the hexon and fiber genes identified the virus as HAdV-7-like for both coding regions. Adenoviruses isolated from respiratory and urine specimens were identical and corresponded to genome type 7d2 by restriction enzyme analysis of viral DNA. The isolated strain encodes a unique fiber gene with a 6-nucleotide deletion corresponding to amino acid positions 250 and 251 in the knob region and not previously described for closely related genomic variants of HAdV-7. Adenovirus detection should be included in the diagnostic testing to determine the infectious etiology of fever and/or respiratory symptoms in SLE patients.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 11/2010; 50(1):80-3. · 3.12 Impact Factor
  • Maya Dewan, Joseph J Zorc, Richard L Hodinka, Samir S Shah
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether cerebrospinal fluid (CSF) enterovirus polymerase chain reaction (PCR) testing of febrile neonates is associated with a shorter hospital length of stay (LOS). Retrospective cohort study. Urban tertiary care children's hospital emergency department. Febrile infants 56 days or younger evaluated by means of lumbar puncture. Performance of CSF enterovirus PCR testing. Hospital LOS. A CSF enterovirus PCR test was performed in 361 of 1231 eligible infants (29.3%); 89 of those tested (24.7%) were positive. The median LOS was 2 days. In multivariable analysis, CSF enterovirus PCR testing was associated with a 26.0% shorter LOS for infants with a positive test result (adjusted beta coefficient, -0.305; 95% confidence interval, -0.457 to -0.153; P < .001) and an 8.0% longer LOS for those with a negative test result (0.075; -0.021 to 0.171; P = .12) compared with untested infants. In stratified analysis, LOS was shorter for all infants 28 days or younger who tested positive regardless of receipt of antibiotics before lumbar puncture. For infants 29 to 56 days old, a positive test result was associated with a shorter LOS only in those not previously receiving antibiotics. The median (interquartile range) turnaround time for CSF enterovirus PCR testing was 22.2 (15.1-27.4) hours, with no effect of turnaround time on LOS. Among infants 56 days or younger, a positive CSF enterovirus PCR test result was associated with a shorter LOS compared with untested infants. The CSF enterovirus PCR test may improve the care of infants with fever.
    JAMA Pediatrics 09/2010; 164(9):824-30. · 4.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A dramatic diminution in the number of rotavirus gastroenteritis cases during the 2007 to 2008 rotavirus season in the United States was likely attributable to the availability of an effective rotavirus vaccine for infants since February 2006. To exclude the possibility that factors other than vaccination accounted for the declining case frequency, we examined the 2008 to 2009 experience at the Children's Hospital of Philadelphia (CHOP). Infants with acute gastroenteritis presenting to CHOP have been monitored for the presence of rotavirus antigen in the stool by enzyme-linked immunosorbent assay (followed by serotyping if enzyme-linked immunosorbent assay-positive) since the 1994 to 1995 epidemic season. The number of community-acquired cases during the last full rotavirus season before licensure of a vaccine was 271 in 2005 to 2006, followed by 167 cases in 2006 to 2007 and 36 in 2007 to 2008. Between 2008 and 2009, 73 community-acquired cases were identified. Almost half of the cases were seen among children older than 2 years. Unlike the late-appearing 2007 to 2008 season, the 2008 to 2009 season paralleled the typical time course observed in the prevaccine era. G9P[8] strains caused 64% of the cases. The sustained decline in the frequency of community-acquired rotavirus gastroenteritis has likely resulted from the use of the new rotavirus vaccines. The age distribution of children hospitalized for rotavirus gastroenteritis has shifted toward older children with the introduction of effective vaccines. The G9 serotype (not included in either vaccine) emerged as the most common cause of rotavirus gastroenteritis at CHOP during the 2008 to 2009 season.
    The Pediatric Infectious Disease Journal 08/2010; 29(8):699-702. · 3.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To identify factors associated with cerebrospinal fluid (CSF) pleocytosis among infants aged 90 days or younger with enterovirus (EV) infections of the central nervous system (CNS). This is a retrospective cohort study performed at an urban academic children's hospital. Patients aged 90 days or younger with a positive CSF EV polymerase chain reaction (PCR) test result obtained during the EV seasons from 2000 to 2006 were included. Patients with concomitant serious bacterial illness or herpes simplex virus infection were excluded. Multivariable logistic regression was used to identify factors independently associated with CSF pleocytosis. A total of 159 patients had a positive CSF EV PCR test result during the study period; 5 (3.1%) were excluded for concurrent serious bacterial infection. The median CSF white blood cell (WBC) count was 110/microL (interquartile range, 11-311/microL). Cerebrospinal fluid pleocytosis was present in 109 patients (71%). The proportion of infants with CSF pleocytosis accompanying EV CNS infections increased with age; CSF pleocytosis was present in 59%, 74%, and 90% of infants aged 0 to 28, 29 to 56, and 57 to 90 days, respectively (P = 0.007). Age and peripheral WBC count were independently associated with CSF pleocytosis. Among infants with EV CNS infections, the absence of CSF pleocytosis is related to younger age and lower peripheral WBC counts, perhaps reflecting the decreased ability of younger infants to mount a robust inflammatory response to EV infection. Thus, CSF EV PCR testing may be warranted in select patients without CSF pleocytosis.
    Pediatric emergency care 02/2010; 26(2):77-81. · 0.92 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine whether ordering testing of cerebrospinal fluid (CSF) for herpes simplex virus (HSV) by polymerase chain reaction (PCR) in neonates and young infants is associated with increased hospital length of stay (LOS) or increased hospital charges. This retrospective cohort study enrolled infants age <or=56 days who underwent lumbar puncture in the emergency department in 2005-2006. The primary "exposure" was CSF HSV PCR, and the primary outcomes were LOS and hospital charges. CSF HSV PCR was performed in 282 of 889 eligible infants (31.7%). The median test turnaround time was 22 hours. The median LOS was 2 days, and median hospital charge was $10 166. In multivariate analysis, CSF HSV PCR testing was associated with a LOS increase of 28% for infants age <or=28 days and 39% for infants age 29-56 days. LOS increased by 22% for every 12-hour increase in test turnaround time. CSF HSV PCR testing was associated with a 41% increase in hospital charges. In infants evaluated by lumbar puncture in the emergency department, CSF HSV PCR testing was associated with a significantly longer LOS and higher hospital charges.
    The Journal of pediatrics 02/2010; 156(5):738-43. · 4.02 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cerebrospinal fluid (CSF) white blood cell (WBC) counts for neonates and young infants are usually interpreted on the basis of values reported in reference texts or handbooks; however, current reference texts either present normal CSF parameters without citation or cite studies with significant limitations. The objective of this study was to determine accurate, age-specific reference values for CSF WBC counts in a large population of neonates and young infants. This cross-sectional study included patients who were aged < or =56 days and had a lumbar puncture performed in the emergency department from January 1, 2005, to June 30, 2007. Patients were excluded from analysis for conditions that are suspected to cause CSF pleocytosis, including traumatic lumbar puncture, serious bacterial infection, congenital infection, seizure, and presence of a ventricular shunt. Children who tested positive for enterovirus (EV) in the CSF by polymerase chain reaction were also excluded. Two-sample Wilcoxon rank-sum tests were used to compare median CSF WBC values of those who had negative EV testing with those who did not have EV testing. A total of 380 (36%) of 1064 patients met inclusion criteria; 54% were male, 15% were preterm, and 39% presented during EV season. The median CSF WBC count was significantly higher in infants who were aged < or =28 days (3/microL, 95th percentile: 19/microL) than in infants who were aged 29 to 56 days (2/microL, 95th percentile: 9/microL; P < .001). In both age groups, infants with a negative EV PCR had a higher upper bound of the 95% confidence interval of the mean values compared with infants who did not have EV testing performed. We determined age-specific CSF WBC reference values in a large cohort of neonates and young infants that can be used to interpret accurately the results of lumbar punctures in this population.
    PEDIATRICS 02/2010; 125(2):257-64. · 4.47 Impact Factor

Publication Stats

1k Citations
303.78 Total Impact Points

Institutions

  • 1998–2013
    • University of Pennsylvania
      • • Department of Pathology and Laboratory Medicine
      • • Division of Infectious Disease
      • • Department of Pediatrics
      Philadelphia, Pennsylvania, United States
  • 1992–2013
    • The Children's Hospital of Philadelphia
      • • Department of Pediatrics
      • • Division of Infectious Diseases
      • • Department of Pathology and Laboratory Medicine
      • • Department of Emergency Medicine
      Philadelphia, Pennsylvania, United States
  • 1992–2011
    • Hospital of the University of Pennsylvania
      • • Division of Infectious Diseases
      • • Department of Medicine
      • • Department of Pathology and Laboratory Medicine
      Philadelphia, Pennsylvania, United States
  • 2010
    • Lovelace Respiratory Research Institute
      Albuquerque, New Mexico, United States