The clinical impact of PCR‐based point‐of‐care diagnostic in respiratory tract infections in children

Abstract

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: Children are commonly affected by respiratory tract infections. Based on clinical symptoms, laboratory evaluation, and imaging, the causative pathogen often cannot be delineated. Point-of-care-testing systems that provide an opportunity for fast detection of common viruses and some bacteria can therefore influence treatment's options. We aimed to examine whether the Biofire® FilmArray® has an effect on antibiotic treatment, duration of antibiotic therapy, and length of hospital stay within a pediatric cohort. Methods:We included children who were admitted to inpatient treatment with an acute respiratory tract infection from 02/2017 to 04/2018 using the FA respiratory panel for pathogen detection. The study group data were compared to the retrospective data of children admitted from 02/2016 to 02/2017, using a proprietary multiplex RT-PCR. Results:A total of 322 children of the study group and 464 children of the control group were analyzed for clinical symptoms, laboratory findings, antibiotic treatment, and length of hospital stay. There was no significant reduction (P < .05) of antibiotic treatment and length of hospital stay. CRP, prehospital antibiotic treatment, antibiotic treatment, past medical history, age, and further pathogen detection showed a significant impact on antibiotic therapy, duration of antibiotic treatment, and length of hospital stay. Conclusion:The use of the FA did not result in a significant reduction of antibiotic treatment or in length of hospital stay. Other parameters had a more significant impact. Therefore, we suggest that standard operation procedures with therapy guidelines are necessary to provide an effective application of POCT systems. K E Y W O R D S acute respiratory tract infections, antibiotic treatment, Biofire® FilmArray®, multiplex RT-PCR, point-of-care-testing How to cite this article: Reischl AT, Schreiner D, Poplawska K, et al. The clinical impact of PCR-based point-of-care diagnostic in respiratory tract infections in children. J Clin Lab

Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children

“… 20 , 21 , 22 There have been 2 earlier RCTs investigating the impact of testing for multiple respiratory pathogens in acutely ill children (eTable 2 and eTable 3 in Supplement 2 ). 14 , 23 , 24 , 25 , 26 Rapid testing of 204 children for 7 respiratory viruses using a direct immunofluorescence assay significantly reduced the prescription of antibiotics after discharge from the ED, 14 although, in a recently published RCT involving 908 children with influenza-like illnesses, the use of rapid respiratory pathogen testing in the pediatric ED did not reduce the overall prescribing of antibiotics. 27 Moreover, the accompanying intention-to-treat analyses showed that children subjected to rapid multipathogen testing were even more likely to receive antibiotics.…”

Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

“…No significant difference in oseltamivir prescription was noted when comparing FA-RP to the standard test (OR = 0.70, 95% CI 0.22–2.24, p = 0.55; I 2 = 84%) ( Figure 6 A) [ 32 , 33 , 46 , 48 , 51 ], which is confirmed in the sub-group analysis stratified by country (Europe and the US, see Figure S4A ). When comparing the use of FA-RP vs. clinical diagnosis of influenza [ 38 , 47 , 49 ], there was an increased trend in prescriptions but without a significant difference (OR = 2.94, 95% CI 0.48–17.86, p = 0.24; I 2 = 95%) ( Figure 6 B).…”

“…When comparing the use of FA-RP vs. standard test, an overall reduction in antibiotic prescriptions was noted (OR = 0.59, 95% CI 0.37–0.92, p = 0.02) [ 32 , 33 , 37 , 40 , 41 , 46 , 51 ], however, with a high heterogeneity (I 2 ) of 89% ( Figure 4 A). In a subgroup analysis stratified by countries, this reduction was more significant in the studies conducted in the US compared to Europe and East Asia (see Figure S1A ).…”

“…A meta-analysis was possible only for three observational studies [ 31 , 33 , 41 ], which compared the use of FA-RP vs. standard tests for the duration of therapy in inpatients. No significant difference was found (see Figure S4B ).…”

Different Clinical Manifestations of Adenoviral Infection Confirmed Using Point-of-Care Testing in a Group of Hospitalized Children

“…As a result, a high C-reactive protein (CRP) level may be noted which can often lead to unnecessary use of antibiotics and hospital admissions. Using of point-of-care (POC) testing for HAdV infections could improve the pre-hospital evaluation, provide the diagnosis, and lead to appropriate therapeutic decisions [ 7 , 8 ].…”