Kitano Taito, Nishikawa Hiroki, Suzuki Rika, Onaka Masayuki, Nishiyama Atsuko, Kitagawa Daisuke, Oka Miyako, Masuo Kazue, Yoshida Sayaka
Department of Pediatrics, Nara Medical University Hospital, 840 Shijo, Kashihara, Nara, 6348521, Japan.
Department of Pediatrics, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan.
J Infect Chemother. 2020 Jan;26(1):82-85. doi: 10.1016/j.jiac.2019.07.014. Epub 2019 Aug 2.
Rapid molecular diagnosis of infections has contributed to timely treatments and antimicrobial stewardship. However, the benefit and cost-effectiveness vary in each country or community because they have different standard practices and health care systems. In Japan, rapid antigen tests (RATs) have been frequently used for pediatric respiratory infections. We investigated the impact and cost-effectiveness of a multiplex PCR (mPCR) respiratory panel for pediatric respiratory infections in a Japanese community hospital.
We replaced RATs with an mPCR respiratory panel (FilmArray®) for admitted pediatric respiratory infections on March 26, 2018. We compared the days of antimicrobial therapy (DOT) and length of stay (LOS) during the mPCR period (March 2018 to April 2019) with those of the RAT period (March 2012 to March 2018).
During the RAT and mPCR periods, 1132 and 149 patients were analyzed. The DOT/case was 12.82 vs 8.56 (p < 0.001), and the LOS was 8.18 vs 6.83 days (p = 0.032) in the RAT and mPCR groups, respectively. The total costs during admissions were ∖258,824 ($2331.7) and ∖243,841 ($2196.8)/case, respectively. Pathogen detection rates were 30.2% vs 87.2% (p < 0.001).
Compared to conventional RATs, the mPCR test contributed to a reduction in the DOT and LOS in a Japanese community hospital for admission-requiring pediatric respiratory infections. However, a proper stewardship program is essential to further reduce the unnecessary usage of antimicrobials.
感染的快速分子诊断有助于及时治疗和抗菌药物管理。然而，由于各国或各社区的标准做法和医疗保健系统不同，其益处和成本效益也有所差异。在日本，快速抗原检测（RAT）已被频繁用于儿科呼吸道感染。我们调查了在日本一家社区医院中，多重聚合酶链反应（mPCR）呼吸道检测板对儿科呼吸道感染的影响和成本效益。
2018年3月26日起，我们将RAT替换为mPCR呼吸道检测板（FilmArray®）用于收治的儿科呼吸道感染患者。我们比较了mPCR时期（2018年3月至2019年4月）和RAT时期（2012年3月至2018年3月）的抗菌治疗天数（DOT）和住院时间（LOS）。
在RAT和mPCR时期，分别分析了1132例和149例患者。RAT组和mPCR组的DOT/病例分别为12.82天和8.56天（p < 0.001），LOS分别为8.18天和6.83天（p = 0.032）。住院期间的总成本分别为每例258,824日元（2331.7美元）和243,841日元（2196.8美元）。病原体检测率分别为30.2%和87.2%（p < 0.001）。
与传统的RAT相比，mPCR检测有助于降低日本一家社区医院中因儿科呼吸道感染而需住院治疗患者的DOT和LOS。然而，适当的管理计划对于进一步减少抗菌药物的不必要使用至关重要。
