Syndromic Multiplex Polymerase Chain Reaction (mPCR) Testing and Antimicrobial Stewardship: Current Practice and Future Directions

Rader, Theodore; Stevens, Michael P.; Bearman, Gonzalo

doi:10.1007/s11908-021-00748-z

Cited by 13 publications

(2 citation statements)

References 53 publications

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“…Prior studies have shown a higher likelihood of antibiotic prescription reduction in settings with active antimicrobial stewardship, a low likelihood of bacterial infection, and short turnaround times. The use of mPCR as an isolated intervention improves microbiological diagnosis but does not consistently decrease antimicrobial utilization [28,29].…”

Section: Discussionmentioning

confidence: 99%

Multiplex PCR and Antibiotic Use in Children with Community-Acquired Pneumonia

del Rosal,

Bote-Gascón,

Falces-Romero

et al. 2024

Children

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Antibiotics are frequently prescribed to children with pneumonia, although viruses are responsible for most cases. We aimed to evaluate the impact of multiplex polymerase chain reaction (mPCR) on antibiotic use. We conducted a prospective study of children under 14 years of age admitted for suspected viral pneumonia, from October 2019 to June 2022 (except March–November 2020). A mPCR respiratory panel (FilmArray® 2plus, bioMérieux, Marcy-l’Étoile, France) was performed within 72 h of admission. Patients with positive reverse transcription PCR for respiratory syncytial virus, influenza, or SARS-CoV-2 were excluded. We compared the patients with historical controls (2017–2018) who had suspected viral pneumonia but did not undergo an aetiological study. We included 64 patients and 50 controls, with a median age of 26 months. The respiratory panel detected viral pathogens in 55 patients (88%), including 17 (31%) with co-infections. Rhinovirus/enterovirus (n = 26) and human metapneumovirus (n = 22) were the most common pathogens, followed by adenovirus and parainfluenza (n = 10). There were no statistically significant differences in the total antibiotic consumption (83% of cases and 86% of controls) or antibiotics given for ≥72 h (58% vs. 66%). Antibiotics were prescribed in 41% of the cases and 72% of the controls at discharge (p = 0.001). Ampicillin was the most commonly prescribed antibiotic among the patients (44% vs. 18% for controls, p = 0.004), while azithromycin was the most commonly prescribed among the controls (19% vs. 48% for patients and controls, respectively; p = 0.001). Our findings underscore the need for additional interventions alongside molecular diagnosis to reduce antibiotic usage in paediatric community-acquired pneumonia.

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Section: Discussionmentioning

confidence: 99%

Multiplex PCR and Antibiotic Use in Children with Community-Acquired Pneumonia

del Rosal,

Bote-Gascón,

Falces-Romero

et al. 2024

Children

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“…To date, most diagnostic stewardship research has focused on the use of these panels for respiratory tract infections. [1][2][3] Clostridioides difficile infection (CDI) is a frequent cause of infectious diarrhea among Veterans. 4 Comprehensive gastrointestinal (GI) PCR testing has been associated with decreased imaging, endoscopy, and antibiotic use, [5][6][7] but the optimal use of this assay remains unclear in the outpatient setting.…”

Section: Introductionmentioning

confidence: 99%

Evaluating outpatient diagnostic stewardship of comprehensive polymerase chain reaction Clostridioides difficile testing in a regional health system

Golovaty,

Tulloch-Palomino

2023

ASHE

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Objective: We examined the use of comprehensive and targeted polymerase chain reaction (PCR) of Clostridioides difficile infection (CDI) among immunocompetent patients with and without CDI risk factors across different outpatient settings. A priori, we expected patients with higher CDI risk to be associated with targeted testing to reflect providers incorporating pretest risk factors in their choice of test assay. Design: Retrospective analysis of adult patients from clinic, emergency room, and non-medically acute inpatient settings. Setting: A tertiary academic medical center offering inpatient and outpatient medical, surgical, mental health, and rehabilitation services to Veterans across the Puget Sound region. Patients: Immunocompetent adult patients with ≥1 stool PCR assay performed between January 2016 and December 2019. Intervention: Patients were tested with either a specific tcdB PCR assay or a comprehensive gastrointestinal PCR panel that tests for 22 pathogens. Results: A total of 2,717 tests (74% targeted, 26% comprehensive) were obtained from 2,156 patients, among which 13% detected C. difficile and 7% detected other organisms. The proportion of comprehensive PCR tests increased nearly four-fold from 2016 to 2019 in clinic and emergency room settings, independent of CDI risk factors. Only two CDI risk factors (prior history of CDI and antibiotic use within three months before testing) were associated with increased targeted testing. Conclusion: The use of comprehensive GI PCR among immunocompetent adults with diarrhea is increasing in the outpatient setting. There may be an opportunity for diagnostic stewardship by nudging providers to consider all CDI risk factors at the time of test selection.

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