Viral Identification Using Multiplex Polymerase Chain Reaction Testing Does Not Reduce Antibiotic Prescribing in
Aurélie Hayotte1,2, Patricia Mariani-Kurkdjian3, Priscilla Boizeau4
1Pediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France.
Viral identification via PCR tests in pediatric intensive care units did not reduce antibiotic use. Antibiotic decisions were primarily driven by clinical severity, CRP levels, and radiology, not viral findings.
Area of Science:
- Pediatric Intensive Care Medicine
- Clinical Microbiology
- Infectious Diseases
Background:
- Polymerase Chain Reaction (PCR) tests for viral identification are increasingly used in respiratory illness diagnosis.
- However, their specific indications and impact on treatment, particularly in pediatric intensive care units (PICUs), remain unclear.
- This study examines the influence of viral detection on antibiotic prescribing practices in a PICU setting.
Purpose of the Study:
- To evaluate the effect of viral identification using PCR on antibiotic therapy management in hospitalized pediatric intensive care unit patients.
- To determine if viral detection influences decisions regarding antibiotic initiation, continuation, or de-escalation.
Main Methods:
- A single-centre retrospective study was conducted from October 2017 to December 2019.
- Included were all consecutive FilmArray® Respiratory Panel PCR tests performed on patients admitted to the PICU.
- Data were extracted from medical records, focusing on reasons for testing, viral detection, bacterial co-infections, and antibiotic management.
Main Results:
- A total of 544 tests from 408 patients were analyzed. Pneumonia and bronchiolitis were the most common indications for testing (34% and 24%, respectively).
- Viruses were identified in 70% of cases, with Human Rhinovirus and Respiratory Syncytial Virus being most prevalent. Bacterial co-infection was noted in 25% of patients.
- Viral identification was not significantly associated with a reduction in antibiotic therapy. Multivariate analysis indicated that clinical severity, C-reactive protein (CRP) levels, and radiological findings were the primary drivers of antibiotic management decisions, irrespective of viral detection.
Conclusions:
- Viral identification in PICU patients provides valuable epidemiological data but does not currently appear to influence antibiotic therapy decisions.
- Antibiotic prescription in this setting is predominantly guided by clinical assessment, inflammatory markers, and imaging results.
- Further research may be needed to optimize the utility of viral PCR testing in guiding antimicrobial stewardship in critically ill children.
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