Urgent Bordetella PCR in infants under 3 months, a useful tool in the Pediatric Emergency Department
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Isabel González-Bertolín1, Bárbara Margarita Ochoa-Fernández2, Ivan Bloise3
1Servicio de Urgencias Pediátricas, Hospital La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España.
Insights
Urgent Bordetella-PCR testing in the Emergency Department significantly reduces hospital admissions and antibiotic use for infants under 3 months with suspected whooping cough. This diagnostic approach improves patient management without compromising clinical outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Diagnostic Microbiology
Background:
- Infants under 3 months with suspected whooping cough (pertussis) face high morbidity and mortality.
- Current management often involves broad antibiotic treatment pending diagnostic results.
- Rapid diagnosis is crucial for effective management and resource optimization.
Purpose of the Study:
- To evaluate the impact of implementing urgent Bordetella-PCR testing in the Emergency Department for infants under 3 months.
- To determine if urgent PCR improves patient management by reducing unnecessary interventions.
Main Methods:
- Retrospective cohort study comparing conventional versus urgent Bordetella-PCR testing for infants under 3 months.
- Data collected from March 2011 to December 2017, with urgent testing implemented from December 2015.
- Analysis of diagnostic test results, hospital admissions, and antibiotic treatment initiation.
Main Results:
- Urgent PCR testing led to an 18% reduction in chest X-rays and a significant decrease in hospital admissions (48.5% vs. 66.2%).
- Antibiotic treatment was initiated in only 32% of patients with urgent PCR, compared to 67% with conventional testing.
- No increase in Emergency Department revisits or adverse clinical outcomes was observed.
Conclusions:
- Urgent Bordetella-PCR testing in the Emergency Department is an effective tool for managing infants under 3 months with suspected pertussis.
- This approach helps avoid unnecessary hospitalizations, diagnostic procedures, and antibiotic treatments.
- Implementation of urgent PCR optimizes patient care and resource utilization in pediatric emergency settings.
Introduction:
Whooping cough in patients aged under 3 months has higher rates of morbimortality. Hospitalization and treatment with azithromycin is generally recommended. Many patients with cough without other signs of alarm, are admitted and started antibiotic therapy until a result of Bordetella-PCR is available. This technique, when performed urgently, can provide the diagnosis in a few hours. The objective of this study is to determine if its generalisation in the Emergency Department allows to improve patient management.
Methods:
Retrospective cohort study of patients aged under 3 months who underwent Bordetella-PCR testing from upper respiratory tract secretions since March 2011 to December 2017. From December 2015 the test was performed urgently.
Results:
One hundred and fifty-eight PCR were performed, 16 (10%) were positive for B. pertussis. Negative results (142; 90%) were divided in 2 cohorts: conventional-PCR, with 74 cases, and urgent-PCR, with 68 cases. The 2 groups were homogeneous in terms of clinical and analytical characteristics. In the urgent-PCR group there was 18% reduction in chest X-rays performed (P=.008). There were 33 (48.5%) patients admitted in the urgent-PCR group, compared to 49 (66.2%) in the conventional-PCR (P=.042). Antibiotic treatment was initiated in 32% of the patients in the urgent-PCR group compared to 67% in the conventional-PCR group (P=.000047), without observing any significant increase in the number of visits to the Emergency Department or worse clinical performance.
Conclusions:
The introduction of urgent PCR in the Emergency Department is a useful tool in the management of infants under 3 months of age with suspected pertussis, since it can avoid unnecessary admissions, diagnostic tests and antibiotic treatments.
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