Impact of respiratory viral polymerase chain reaction testing on de‐escalation of antibiotic therapy in children who require chronic positive pressure ventilation

Abstract

BackgroundChildren who require chronic positive pressure ventilation (CPPV) are frequently hospitalized with acute respiratory infections. Although respiratory viral testing is often performed, it is unclear how positive results impact antibiotic use. We sought to assess the impact of respiratory viral testing on antibiotic use in hospitalized children on CPPV.MethodsThis retrospective cohort study included hospitalized children on CPPV who had respiratory viral polymerase chain reaction (RVP) testing on admission. Primary exposure was a positive RVP result; primary outcome was antibiotic de‐escalation, defined as discontinuation of antibiotics or narrowing of antimicrobial spectra. To determine the independent association of positive RVP and antibiotic de‐escalation, a generalized linear mixed effect model was used to account for within patient clustering and confounders defined a priori (blood and respiratory cultures, leukocytosis, bandemia, chest radiograph findings, aspiration risk, and recent admission).ResultsA total of 200 admissions representing 118 patients were included. A viral pathogen was identified in 46.5% (93/200) of admissions; rhinovirus was most frequently identified (61.5% of positive RVPs). Antibiotic de‐escalation occurred in 33% of admissions (35.5% of RVP‐positive admissions vs 30.8% of RVP‐negative admissions; P = .49). In adjusted analysis, there was no association between positive RVP and antibiotics de‐escalation (adjusted OR: 0.86; 95% confidence interval: 0.32‐2.26).ConclusionThis single center cohort study suggests that respiratory viral testing may not impact antibiotic prescribing for hospitalized children on CPPV. There is need for improved stewardship of both diagnostic testing and antimicrobial use in this population.

Effect of Rapid Respiratory Virus Testing on Antibiotic Prescribing Among Children Presenting to the Emergency Department With Acute Respiratory Illness

“…[7][8][9][10][11][12] Newer molecular-based platforms enable more rapid pathogen detection with enhanced sensitivity and specificity. Although some pediatric studies using these newer platforms have reported associations with decreased antibiotic use and hospital length of stay among inpatients, 10,13 guidance regarding whether the same benefits exist for patients in an ED or urgent care setting is limited in the pediatric population. The objective of this randomized clinical trial was to determine whether knowledge of the pathogen associated with acute respiratory infection affects clinicians' decision-making regarding antibiotic prescribing and health care use in a pediatric ED setting.…”

Clinical characteristics and illness course based on pathogen among children with respiratory illness presenting to an emergency department

“…Hospitalization rates from common pediatric respiratory viruses have been previously described in the literature 2 . For inpatient settings, prior studies suggest that rapid identification of respiratory infections results in improved outcomes for hospitalized patients, including decreased hospitalization rates, shorter length of stay, decreased antibiotic use, and improved antiviral use 6,7 . However, less is known about the clinical impact of viral identification for children being evaluated in the ED setting, and whether knowledge of the specific respiratory pathogen can inform clinical outcomes and illness course for these children.…”

“…2 For inpatient settings, prior studies suggest that rapid identification of respiratory infections results in improved outcomes for hospitalized patients, including decreased hospitalization rates, shorter length of stay, decreased antibiotic use, and improved antiviral use. 6,7 However, less is known about the clinical impact of viral identification for children being evaluated in the ED setting, and whether knowledge of the specific respiratory pathogen can inform clinical outcomes and illness course for these children. Therefore, the objectives of this study were to explore the clinical characteristics, hospitalization risk, and symptom duration by the respiratory pathogen, of children with acute respiratory infections (ARI) evaluated in an ED setting.…”