Viral Identification Using Multiplex Polymerase Chain Reaction Testing Does Not Reduce Antibiotic Prescribing in Paediatric Intensive Care Units

Abstract

PCR tests for viral identification, performed on nasopharyngeal secretions, have experienced a major boom in the last few years. Their use is very frequent, but their indications are still not well defined, especially in Paediatric Intensive Care Units (PICU). These tests are used for the microbiological diagnosis of lower respiratory infections but can be used in other situations. The aim of the study was to investigate the effect of viral identification on antibiotic therapy management. We conducted a single-centre retrospective study from 1 October 2017 to 31 December 2019. This study included all consecutive FilmArray® Respiratory Panel tests performed in patients hospitalised in a PICU. Patients were identified using the microbiology laboratory prospective database and data were extracted from the medical record. 544 tests corresponding to 408 patients were included. The main reasons for testing were pneumonia (34%) and bronchiolitis (24%). In 70% of cases, at least one virus was identified, with Human Rhinovirus (56%) and Respiratory Syncytial Virus (28%) being the two predominant. Bacterial co-infection was present in 25% of cases. Viral identification was not associated with reduced antibiotic therapy. On multivariate analysis, antibiotic management was significantly associated with clinical gravity, CRP value or radiology findings regardless of virus identification. Viral identification has an epidemiological value, but antibiotic prescription relies on other factors.

Respiratory Coinfections in Children With SARS-CoV-2

“…One possible explanation for this may be differences in the indication for testing of children in the ED versus later during their clinical course in the ICU or inpatient floors. 25 Overall, these data suggest that respiratory coinfections in children with SARS-CoV-2 are common, and they are most often observed in young children presenting to the ED.…”

Impact of Nested Multiplex Polymerase Chain Reaction Assay in the management of pediatric patients with acute respiratory tract infections: a single center experience

“…Also, El-Nawawy et al reported that BioFire was associated with a 33.3% increase in positive specimens when compared to conventional methods [14]. Hayotte et al found that at least one target was identified by BPPP in (70%) of patients [15]. Positive BioFire results with negative bacterial culture may be related to multiple factors: low count of the isolate on culture plates compared to the cut-off which is therefore not reported, unavailability of culture media that support growth of fastidious bacteria, PCR may detect non-viable organisms, in addition to the antibiotic misuse which may inhibit growth on culture media, also the fact that the count released by BioFire is in the form of copies/ml which is greater when compared to the culture count in the form of CFU/ml [16].…”

“…Similarly, El-Nawawy et al found that HR/EV was the most frequently detected virus (n=21, 29.2%) followed by RSV (n=19, 26.4), Influenza A (n=8;11.1) and Adenovirus (n=7, 9.7%) [14]. Also, Hayotte and his colleagues reported that Human Rhinovirus (n=215,56%) and RSV(n=106, 28%) were the two predominant targets identified by BioFire followed by Adenovirus (n=55, 14%), Parainfluenza (n=48, 13%), Human metapneumovirus (n=25, 7%), Influenza (n=26, 7%) and Coronavirus (n=24, 6%) [15]. This can be due to the decreased RSV infections owing to Palivizumab prophylaxis [20].…”

“…Hayotte and his colleagues stated that bacterial coinfection was present in 25% of cases [15]. Molecular detection of more than one target requires correlation with the patient clinical status, Gram stain, specimen type; where sputum samples are more susceptible to oropharyngeal contamination compared to ETA or BAL, in addition to target detection level, other laboratory test; CRP, TLC and radiological findings to differentiate between infection versus colonization, since, depending on the FilmArray results solely could lead to antimicrobial overuse.…”