THỰC TRẠNG VÀ GIẢI PHÁP CẢI THIỆN CHẨN ĐOÁN, ĐIỀU TRỊ VIÊM MÀNG NÃO DO ENTEROVIRUS Ở TRẺ EM TẠI BỆNH VIỆN NHI TRUNG ƯƠNG (2024–2025)

Abstract

Enteroviral meningitis (EVM) is the most common cause of viral meningitis in children, but it is often difficult to differentiate from bacterial meningitis at the time of admission, leading to unnecessary antibiotic use. This study aimed to: Describe the current status of diagnosis, treatment and propose some measures to improve the treatment of meningitis caused by EV at the National Children's Hospital in 2024-2025. Methods: We conducted a combined retrospective (January 2024 to April 2025) and prospective (May to October 2025) descriptive study on children aged 1 month to 18 years diagnosed with EVM confirmed by cerebrospinal fluid (CSF) polymerase chain reaction (PCR). Results: A total of 500 patients were included. The mean age was 4.6 ± 1.2 years, with aged 2–6 years (43.4%). Male (57.4%). The median time from symptom onset to admission was 1.4 days. The main reasons for hospitalization were headache (71.6%), fever (66.0%), and vomiting (42.8%). At lower-Local hospitals, only 27.4% underwent lumbar puncture and 48.9% of those received CSF PCR testing. Antibiotics were administered to 57.5%, with significantly higher rates in those without lumbar puncture (75.8% vs. 8.8%, p=0.02). Multivariate analysis showed that age <6 months, high fever, CSF WBC >100 cells/mm³, and CRP >10 mg/L were associated with higher likelihood of antibiotic prescription, whereas PCR performed within 24h reduced antibiotic use. Treatment outcomes were excellent: 99.6% recovered completely, with no significant difference between groups receiving antibiotics and those not receiving antibiotics (p=0.92). Conclusion: Pediatric EVM in Vietnam predominantly affects children aged 1–6 years and presents with non-specific symptoms. Lumbar puncture and PCR testing at lower-level hospitals contributes to high rates of unnecessary antibiotic administration. Early CSF PCR testing is crucial to confirm diagnosis, guide antibiotics stewardship, and optimize patient management.