Rapid diagnosis of acute pediatric respiratory infections with Point-of-Care and multiplex molecular testing

Acute infections of the respiratory tract are very common in pediatric patients, with an estimated global incidence of 17.2 billion cases in 2019. Accurate and timely diagnosis and treatment of acute respiratory infections can prevent progression to more serious pathologies, especially in the young, elderly, immunocompromised, and other high-risk groups. Due to the significant increase in the number of multiplex molecular tests available, there are now many diagnostic options which generate results within minutes or hours, many of which can be performed at point-of-care or near-patient rather than being sent out to a centralized laboratory. Rapid molecular single- or multiplex testing conducted at point-of-care or near-patient offers the potential to improve timely and accurate diagnosis, decrease inappropriate antibiotic use, decrease reliance on chest radiographs, improve timely antiviral administration, reduce the length of hospital stay, reduce the number of clinical visits, and, ultimately, improve patient outcomes. Optimal use of user-friendly multiplex molecular panels also has the potential to improve regional and global disease surveillance and to fill gaps that exist in our understanding of the epidemiology of respiratory infections. These potential benefits, however, come with limitations. For example, use of multiplex PCR assays is not always a cost effective approach. Despite their potential, there are clinical and/or laboratory circumstances where their use becomes cost prohibitive. Another recognized limitation of multiplex PCR assays is that the pathogen detected may not be the cause of a patient's current symptom complex. Such false positive results may occur because the assays are designed to detect pathogen-specific nucleic acid (which may be residual from a prior illness), rather than replication competent pathogens, or because some pathogens can be present without causing symptomatic infection. Further study is needed to determine optimal use of these tests across different patient groups and settings. Incorporating recommendations for best practice use of multiplex molecular assays into clinical guidelines helps offer a framework for their most appropriate use in the diagnosis of pediatric acute respiratory infections.