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Rapid Molecular Detection and Differentiation of Influenza Viruses A and B
Published on: January 30, 2017
Utilization of viral molecular diagnostics among children hospitalized with community acquired pneumonia
Grant S Schulert1, Paul D Hain2, Derek J Williams3
1Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; and grant.schulert@cchmc.org.
Insights
Respiratory viral panel (RVP) testing in children hospitalized with pneumonia did not alter antibiotic use. However, positive RVP results, particularly for respiratory syncytial virus, were linked to more severe illness in younger patients.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Diagnostic Microbiology
Background:
- Community-acquired pneumonia (CAP) is a common reason for pediatric hospitalization.
- Accurate and rapid diagnosis of respiratory pathogens is crucial for effective management.
- Respiratory viral panels (RVPs) offer multiplex detection of various respiratory viruses.
Purpose of the Study:
- To determine if RVP results influence antibiotic prescribing practices in children with pneumonia.
- To investigate the association between RVP findings and clinical outcomes in hospitalized pediatric pneumonia patients.
- To evaluate the impact of RVP testing on antibiotic initiation and duration.
Main Methods:
- Retrospective cohort study of hospitalized children with CAP over 3 years.
- RVP testing performed within 24 hours of admission for eligible patients.
- Analysis of associations between RVP results, clinical course, and antibiotic management.
Main Results:
- A positive RVP was identified in 63% of 202 children.
- Positive RVP results were associated with more complicated clinical courses, especially in younger children and those with respiratory syncytial virus (RSV).
- RVP detection did not significantly alter antibiotic therapy initiation or duration.
Conclusions:
- RSV detection was the primary driver of a more severe clinical course compared to RVP-negative cases.
- RVP positivity did not impact antibiotic usage, irrespective of the detected virus.
- Current RVP use predominantly targets children with severe pneumonia; its effect on less severe cases warrants further investigation.
Objective:
To examine whether results of a polymerase chain reaction-based respiratory viral panel (RVP) are associated with changes in antibiotic use or differential clinical outcomes among children hospitalized with pneumonia.
Methods:
We retrospectively identified otherwise healthy children hospitalized over a 3-year period at a single institution with community-acquired pneumonia who had an RVP performed within 24 hours of admission. We examined associations between RVP results and clinical outcomes as well as management decisions including initiation and duration of intravenous antibiotics.
Results:
Among 202 children, a positive RVP (n = 127, 63%) was associated with a more complicated clinical course, although this was due largely to more severe disease seen in younger children and those with respiratory syncytial virus (n = 38, 30% of positive detections). Detection of a virus did not influence antibiotic therapy. Included children were younger and had more severe illness than children hospitalized with pneumonia at the same institution without an RVP obtained.
Conclusions:
In our study, only respiratory syncytial virus was associated with a more severe clinical course compared with RVP-negative children. Regardless of the virus detected, RVP positivity did not influence antibiotic usage. However, RVP use focused primarily on children with severe pneumonia. Whether similar testing influences management decisions among children with less severe illness deserves further study.
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