Etiological diagnosis reduces the use of antibiotics in infants with bronchiolitis

Abstract

OBJECTIVE:Acute bronchiolitis is a leading cause of infant hospitalization and is most commonly caused by respiratory syncytial virus. Etiological tests are not required for its diagnosis, but the influence of viral screening on the therapeutic approach for acute bronchiolitis remains unclear.METHODS:A historical cohort was performed to assess the impact of viral screening on drug prescriptions. The study included infants up to one year of age who were hospitalized for bronchiolitis. Virus screening was performed using immunofluorescence assays in nasopharyngeal aspirates. The clinical data were obtained from the patients' medical records. Therapeutic changes were considered to be associated with viral screening when made within 24 hours of the release of the results.RESULTS:The frequency of prescriptions for beta agonists, corticosteroids and antibiotics was high at the time of admission and was similar among the 230 patients. The diagnosis of pneumonia and otitis was associated with the introduction of antibiotics but did not influence antibiotics maintenance after the results of the virus screening were obtained. Changes in the prescriptions were more frequent for the respiratory syncytial virus patients compared to patients who had negative viral screening results (p = 0.004), especially the discontinuation of antibiotics (p<0.001). The identification of respiratory syncytial virus was associated with the suspension of antibiotics (p = 0.003), even after adjusting for confounding variables (p = 0.004); however, it did not influence the suspension of beta-agonists or corticosteroids.CONCLUSION:The identification of respiratory syncytial virus in infants with bronchiolitis was independently associated with the discontinuation of antibiotics during hospitalization.

Analytical performance of the automated multianalyte point-of-care mariPOC® for the detection of respiratory viruses

“…Although molecular assays represent the gold standard for diagnosing viral ARI, nucleic acids of respiratory viruses in asymptomatic individuals have been demonstrated (Jansen et al, 2011). Furthermore, as NAATs are usually associated with longer response time and higher costs, the use of point-of-care antigen detection methods in healthcare settings have demonstrated clinical benefits (Benito-Fernández et al, 2006;D'Heilly et al, 2008;Ferronato et al, 2012). Rapid detection of viral respiratory pathogens is also important for taking appropriate isolation measures of confirmed cases in order to prevent nosocomial outbreaks, especially during Flu and RSV epidemic.…”

“…Rapid etiological diagnosis of ARI improves patients' management, as it allows for appropriate and on-time antiviral therapy, which has demonstrated a reduction of complications, duration of symptoms, and hospital stay (D'Heilly et al, 2008;Fiore et al, 2011). Indeed, rapid diagnosis avoids the use of unnecessary antibiotics and ancillary diagnostic studies (Ferronato et al, 2012;Benito-Fernández et al, 2006).…”

Diagnostic Accuracy of Rapid Antigen Detection Tests for Respiratory Syncytial Virus Infection: Systematic Review and Meta-analysis

“…Because concurrent serious bacterial infection with RSV is uncommon, especially in children (6), a timely diagnosis of RSV ARI should diminish unnecessary antibiotic use (7)(8)(9). It may also minimize ancillary testing (10), decrease hospital stay durations (11), and permit prompt implementation of cohort assignment for the purpose of limiting nosocomial transmission within hospitals and long-term-care facilities (13)(14)(15)(16)57).…”

Clinical and economical impact of multiplex respiratory virus assays

“…Even though multiplex PCR assays can detect several different viruses simultaneously and rapidly, their advantages in terms of cost reduction over other rapid diagnostic assays (DFA, antigen detection) are still unclear. When rapid antigenic diagnostic tests for viral infections became widely used, several studies demonstrated their clinical utility in reducing length of hospital stay, performance of ancillary diagnostic tests and antibiotic consumption among pediatric (Bonner et al, 2003;Esposito et al, 2003;Sharma, 2002;Woo et al, 1997) (Abanses et al, 2006;Benito-Fernández et al, 2006;Byington et al, 2002;Ferronato et al, 2012;Iyer et al, 2006;Noyola & Demmler, 2000) and adult (Barenfanger et al, 2000;D'Heilly et al, 2008;Falsey et al, 2007) populations. Their cost-effectiveness was also shown with both populations (Barenfanger et al, 2000;Woo et al, 1997).…”