Utility of Rapid Nasopharyngeal Swab for Respiratory Pathogens in the Diagnosis of Viral Infections in Children Hospitalized with Fever: A Prospective Validation Study to Improve Antibiotic Use

Abstract

Introduction: Fever is among the most common reason for medical assessment and antibiotic prescription in practice. The aim of this study was to evaluate positive and negative predictive values of rapid nasopharyngeal swabs for respiratory pathogens to discriminate viral from bacterial infections. Methods: We prospectively tested children with signs and/or symptoms of infections (e.g., fever, cough, wheezing, suspected urinary tract infection) admitted to a paediatric department. Following discharge, clinical phenotypes were assigned defining a cohort of children having probable/certain viral infection, probable/certain bacterial infection, other inflammatory conditions or healthy controls. Results: In this study, 190 children were enrolled (50.5% females, median age 30.5 (8–86) months). In total, 102 patients (53.7%) were affected by respiratory viral infections, 16 (8.4%) by bacterial infections, 29 (15.3%) were healthy controls and 43 (22.6%) were affected by another pathological condition manifested with fever. In total, 84.3% of patients classified as viral infection tested positive for viruses, compared with 18.8% of patients with bacterial infection (p < 0.001), 18.6% of patients with other condition (p < 0.001) and 17.2% of control patients (p < 0.001). The positive predictive value of NPSs in the diagnosis of viral infection was 88.6% and the negative predictive value was 75.0%. Conclusion: Our findings suggest that rapid NPS tests for respiratory viruses are a useful tool to confirm viral infections in children with fever and improve antibiotic use.

Determinants of antibiotic prescription in children with adenovirus respiratory tract infections

“…However, the most recent guidelines of the American Academy of Pediatrics have changed this approach, and currently included recommendations for safe withholding of empirical antibiotics in well appearing infants with normal inflammatory markers, even in the age range of 21 to 90 days of life [33]. In our cohort, of the children younger than 1 year of age, only 9 were younger than 90 days of life, and this may explain why children < 12 months old received less antibiotics, in addition to the application in our Pediatric departments of the latest AAP guidelines, along with other antibiotic stewardship practices based on viral testing [31].…”

“…5s). Our hypothesis is that, since the pandemic, our center has obtained more experience in the interpretation of viral testing (as we reviewed in a recent study analyzing antibiotic stewardship programs in the emergency department [30], being more prone in not routinely using antibiotic in these patients as presented in a flowchart that we published elsewhere [31]. Interestingly, we found that children under 1 year of age were at lower risk of receiving antibiotics.…”

Procalcitonin and Presepsin as Markers of Infectious Respiratory Diseases in Children: A Scoping Review of the Literature

“…Based on these findings, it does not currently seem safe to propose a protocol based exclusively on procalcitonin to reduce antibiotic use in pediatric respiratory infections, as this marker does not consistently exhibit adequate sensitivity and specificity values. Or, at least, clinical judgment should always be taken into consideration, and results should be interpreted on the bases of other antimicrobial stewardship interventions that are of possible application in the pediatric emergency setting [ 71 , 72 ]. In fact, our study does not exclude a role of PCT in recognizing bacterial infections, but simply highlights that PCT results should not be interpreted as a golden rule, as they may be imperfect.…”