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Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial
Suvi Mattila1,2, Niko Paalanne1,2, Minna Honkila1,2
1Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland.
Insights
Multiplex polymerase chain reaction (PCR) point-of-care testing for respiratory pathogens did not reduce antibiotic use in acutely ill children. This testing showed limited impact on clinical decisions in the pediatric emergency department.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Clinical Diagnostics
Background:
- Limited data exist on the clinical impact of multiplex polymerase chain reaction (PCR) point-of-care testing for respiratory pathogens in acutely ill children.
- Antibiotic overuse remains a significant concern in pediatric emergency care.
Purpose of the Study:
- To evaluate the effect of multiplex PCR point-of-care testing on antibiotic prescribing in acutely ill children presenting to the emergency department.
- To assess the impact of rapid diagnostic testing on clinical decision-making and resource utilization.
Main Methods:
- An unblinded, randomized clinical trial involving 1243 children (aged 0-17 years) with respiratory symptoms.
- Participants were randomized to either multiplex PCR point-of-care testing (results within 70 minutes) or routine care.
- Primary outcome was the proportion of children receiving antibiotic therapy; secondary outcomes included diagnostic tests, imaging, and costs.
Main Results:
- Multiplex PCR point-of-care testing did not significantly reduce overall antibiotic prescribing (27.3% vs 28.5%).
- Targeted antibiotic therapy increased in the intervention group (1.4% vs 0.5%).
- Diagnostic test utilization and costs did not differ between the groups.
Conclusions:
- Point-of-care multiplex PCR testing for respiratory pathogens did not decrease antibiotic use in this pediatric emergency department setting.
- Current respiratory pathogen point-of-care testing has a limited impact on antibiotic prescribing and clinical decision-making for acutely ill children.
Importance:
Limited data are available on the clinical impact of multiplex polymerase chain reaction (PCR) point-of-care testing for respiratory pathogens in acutely ill children.
Objective:
To evaluate the effect of multiplex PCR point-of-care testing for respiratory pathogens on antibiotic use in acutely ill children.
Design, Setting, And Participants:
This unblinded, randomized clinical trial was conducted from May 6, 2019, through March 12, 2020. The participants were followed up until hospitalization or discharge from the emergency department (ED) for primary outcome. The study was conducted at the pediatric ED of Oulu University Hospital, Finland. Eligible study participants were children aged 0 to 17 years with fever and/or any respiratory signs or symptoms. Children with underlying medical conditions were included. The statistical analyses were performed between August 11, 2020, and September 14, 2021.
Interventions:
The participants were randomly assigned in a 2:1 ratio either to undergo multiplex PCR point-of-care testing (18 respiratory viruses and 3 bacteria with results ready within 70 minutes) upon arrival at the ED or to receive routine care.
Main Outcomes And Measures:
The primary outcome was the proportion of children receiving antibiotic therapy. The secondary outcomes were the numbers of diagnostic tests and radiographic imaging procedures performed and costs.
Results:
A total of 1417 children were assessed for eligibility. After exclusions, 1243 children (692 boys [56%]) were randomly allocated to either the intervention (829 children) or control (414 children) group. The mean (SD) age of the participants was 3.0 (3.6) years in the intervention group (median [IQR], 1.7 [0.4-4.1] years) and 3.0 (3.5) years (median [IQR], 1.9 [0.4-4.1] years) in the control group. Multiplex PCR point-of-care testing for respiratory pathogens did not reduce the overall prescribing of antibiotics in the emergency department (226 children [27.3%] in the intervention group vs 118 children [28.5%] in the control group; risk ratio, 0.96; 95% CI, 0.79-1.16). Targeted antibiotic therapy was started in 12 children (1.4%) tested with point-of-care multiplex PCR and 2 children (0.5%) in the control group (risk ratio, 3.0; 95% CI, 0.76-11.9). The numbers of diagnostic tests did not differ between the groups, nor did the costs.
Conclusions And Relevance:
In this randomized clinical trial, point-of-care testing for respiratory pathogens did not reduce the use of antibiotics at the pediatric ED. Testing for respiratory pathogens appears to have a limited impact on clinical decision-making for acutely ill children.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03932942.
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