McCulloh Russell J, Andrea Sarah, Reinert Steven, Chapin Kimberle
Division of Pediatric Infectious Diseases, Children's Mercy Hospital, Kansas City, Missouri.
Department of Pathology, Rhode Island Hospital.
J Pediatric Infect Dis Soc. 2014 Jun;3(2):146-53. doi: 10.1093/jpids/pit073. Epub 2013 Nov 13.
Multiplex real-time polymerase chain reaction respiratory viral panel (RVP) testing offers enhanced test performance characteristics compared with older testing methods. However, the impact of RVP testing on physician antimicrobial prescription practices remains unclear. Our objective was to assess the potential relationship of RVP testing to physician treatment practices for children hospitalized with acute respiratory illness (ARI).
We performed a retrospective chart review of children hospitalized for ARI during peak prevalence of respiratory viral infections in 2009-2011. Demographics, diagnostic testing, antimicrobial use, and clinical outcomes were abstracted from the electronic medical record. Antimicrobial use was compared with RVP testing data.
A total of 1727 patients met inclusion criteria. Of these patients, 254 (14.7%) children who were hospitalized for ARI received oseltamivir and 856 (49.6%) children received antibiotics. More children who received oseltamivir were positive for influenza by RVP (76.9% vs 18.0%; P < .0001). Children who underwent RVP testing received antibiotics more often than those who were not tested (53.7% vs 46.0%; P = .001), but children with a positive RVP test result received antibiotics less often (51.6% vs 67.0%; P = .003). A total of 5.8% of children who were positive for a viral pathogen by RVP had antibiotics discontinued. Antibiotics were started in fewer children when RVP results were positive (10.9% vs 100.0%; P < .0001).
Respiratory viral panel testing was associated with more appropriate oseltamivir use in children hospitalized with ARI. Physicians started antibiotics more often in children with a negative RVP test result and occasionally discontinued antibiotics in children diagnosed with a viral pathogen. These results suggest that RVP testing may enhance physician decision-making when prescribing antimicrobials in children hospitalized with ARI.
与传统检测方法相比，多重实时聚合酶链反应呼吸道病毒检测板（RVP）检测具有更好的检测性能。然而，RVP检测对医生抗菌药物处方行为的影响尚不清楚。我们的目的是评估RVP检测与急性呼吸道疾病（ARI）住院儿童的医生治疗行为之间的潜在关系。
我们对2009 - 2011年呼吸道病毒感染高发期因ARI住院的儿童进行了回顾性病历审查。从电子病历中提取人口统计学信息、诊断检测、抗菌药物使用情况和临床结局。将抗菌药物使用情况与RVP检测数据进行比较。
共有1727例患者符合纳入标准。在这些患者中，254例（14.7%）因ARI住院的儿童接受了奥司他韦治疗，856例（49.6%）儿童接受了抗生素治疗。接受奥司他韦治疗的儿童中，RVP检测流感呈阳性的比例更高（76.9%对18.0%；P <.0001）。接受RVP检测的儿童比未检测的儿童更常接受抗生素治疗（53.7%对46.0%；P =.001），但RVP检测结果为阳性的儿童接受抗生素治疗的频率较低（51.6%对67.0%；P =.003）。RVP检测病毒病原体呈阳性的儿童中，共有5.8%停用了抗生素。当RVP结果为阳性时，开始使用抗生素的儿童较少（10.9%对100.0%；P <.0001）。
呼吸道病毒检测板检测与ARI住院儿童更合理地使用奥司他韦有关。医生在RVP检测结果为阴性的儿童中更常开始使用抗生素，而在诊断为病毒病原体的儿童中偶尔会停用抗生素。这些结果表明，RVP检测可能会增强医生对ARI住院儿童开具抗菌药物时的决策能力。
