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Impact of PCR for respiratory viruses on antibiotic use: theory and practice

Alma C van de Pol1, Tom F W Wolfs, Carline E A Tacke

  • 1Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands.

Pediatric Pulmonology
|January 4, 2011
PubMed

Insights

Real-time PCR testing for respiratory viruses did not change antibiotic prescribing habits in pediatric intensive care unit physicians for ventilated children with lower respiratory tract infections, despite survey data suggesting it would reduce antibiotic use.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Microbiology
  • Critical Care Medicine

Background:

  • Real-time polymerase chain reaction (PCR) offers higher sensitivity for respiratory virus detection than direct immunofluorescence (DIF).
  • The cost-effectiveness and clinical impact of integrating real-time PCR into antibiotic prescribing protocols for pediatric lower respiratory tract infections (LRTI) remain under investigation.

Purpose of the Study:

  • To assess the impact of additional real-time PCR testing on antibiotic prescriptions in ventilated children with LRTI admitted to the pediatric intensive care unit (PICU).

Main Methods:

  • A multicenter survey study was conducted, followed by a prospective study involving children (≤ 5 years) with LRTI.
  • Patients were tested via DIF and PCR upon PICU admission; antibiotic treatment was evaluated before and after PCR result disclosure.

Main Results:

  • Survey data indicated PCR use would decrease antibiotic prescriptions (P < 0.001).
  • In the prospective study (38 children), 19 were DIF positive. Among 19 DIF-negative patients, 12 received antibiotics pre-PCR disclosure, with 9 testing positive via PCR.
  • Disclosure of PCR results did not alter antibiotic treatment decisions in the prospective cohort.

Conclusions:

  • Contrary to survey expectations, real-world PICU physician antibiotic prescribing for ventilated children with LRTI was not influenced by the results of additional respiratory real-time PCR testing.
  • The integration of sensitive diagnostic tools like real-time PCR may not directly translate to changes in clinical practice regarding antibiotic stewardship in critically ill children.
Abstract

Keywords:
anti-bacterial agentspatient care managementpediatric intensive care unitsquestionnairesreal-time polymerase chain reactionviral lower respiratory tract infections

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