Byington Carrie L, Castillo Heidi, Gerber Kris, Daly Judy A, Brimley Laurie A, Adams Susan, Christenson John C, Pavia Andrew T
Department of Pediatric Infectious Diseases, University of Utah, 50 N Medical Drive, Salt Lake City, UT 84132, USA.
Arch Pediatr Adolesc Med. 2002 Dec;156(12):1230-4. doi: 10.1001/archpedi.156.12.1230.
Acute viral respiratory disease is the most common reason for pediatric hospitalization in the United States. Viral illnesses may be mistaken for bacterial infection, and antibiotic therapy may be prescribed. Overprescribing of antimicrobials for viral illness is a factor contributing to increasing antimicrobial resistance among bacterial pathogens encountered in pediatrics.
To determine if the availability of a rapid diagnostic test for respiratory viruses would affect antibiotic use in a children's hospital.
Retrospective medical record review.
A 232-bed urban children's hospital.
All hospitalized infants and children who underwent rapid testing (SimulFluor Respiratory Screen; Chemicon International Inc, Temecula, Calif) for respiratory viruses by direct fluorescent assay (DFA) during 2 successive winter seasons.
Rates of antibiotic prescribing in DFA-positive and DFA-negative patients during the 2 study periods.
During the first winter season, DFA-positive patients had fewer days using intravenous antibiotics (2.4 vs 4, P =.04), fewer days using oral antibiotics (0.25 vs 2.5, P =.04), and fewer discharge prescriptions for oral antibiotics (37% vs 52%, P =.02) when compared with DFA-negative patients. Intravenous antibiotics were initiated less often for DFA-positive patients during the second winter season than during the first (26% vs 44%, P =.008).
Direct fluorescent assay testing was associated with a decrease in inappropriate antibiotic use. The availability of rapid viral diagnostics is an important tool for decreasing antibiotic prescribing in pediatric patients.
急性病毒性呼吸道疾病是美国儿童住院治疗最常见的原因。病毒性疾病可能被误诊为细菌感染，从而可能会开出抗生素治疗处方。对病毒性疾病过度开具抗菌药物是导致儿科中遇到的细菌病原体耐药性增加的一个因素。
确定呼吸道病毒快速诊断检测的可用性是否会影响儿童医院的抗生素使用情况。
回顾性病历审查。
一家拥有232张床位的城市儿童医院。
在连续两个冬季期间，所有通过直接荧光检测法（DFA）（使用SimulFluor呼吸道筛查；Chemicon国际公司，加利福尼亚州特梅库拉）进行呼吸道病毒快速检测的住院婴幼儿和儿童。
两个研究期间DFA阳性和DFA阴性患者的抗生素处方率。
在第一个冬季，与DFA阴性患者相比，DFA阳性患者使用静脉抗生素的天数更少（2.4天对4天，P = 0.04），使用口服抗生素的天数更少（0.25天对2.5天，P = 0.04），出院时口服抗生素处方更少（37%对52%，P = 0.02）。在第二个冬季，DFA阳性患者开始使用静脉抗生素的频率低于第一个冬季（26%对44%，P = 0.008）。
直接荧光检测法与减少不适当的抗生素使用有关。快速病毒诊断检测的可用性是减少儿科患者抗生素处方的重要工具。
