Testing for Respiratory Pathogens Does Not Decrease Antibiotic Use in Children

Point-of-care testing for respiratory pathogens via multiplex polymerase chain reaction (PCR) did not decrease inappropriate antibiotic use in children admitted to a pediatric emergency department (ED), according to results of a randomized controlled trial published in JAMA Network Open.

This study included children (age range, 0-17 years) admitted to a pediatric ED with fever and/or any signs or symptoms suggestive of a respiratory infection. Patients were randomly assigned in a 2:1 fashion to receive either multiplex PCR point-of-care testing (intervention group) or routine care (control group). Patients in the intervention group were tested for 18 respiratory viral subtypes and 3 bacterial pathogens. Patients in the control group were eligible to receive multiplex PCR testing only if the treating physician deemed it necessary. The primary outcome was the number of patients who were started on or prescribed antibiotic therapy in the ED.

There were 1243 patients included in the study, of whom 56% were boys, and the mean age was 3 years. Of these patients, 829 were in the intervention group and 414 were in the control group.

Overall, the number of patients who received antibiotic therapy was not significantly different between those in the intervention vs control groups (27.3% vs 28.5%; risk ratio [RR], 0.96; 95% CI, 0.79-1.16). Although the length of ED stay was longer for patients in the intervention group vs those in the control group (182.6 minutes vs 169.4 minutes), the number of patients who required hospitalization or admission to a pediatric intensive care unit did not significantly differ between the groups.

An exploratory analysis showed that patients in the intervention group received pathogen-targeted therapy at a significantly increased rate compared with those in the control group (RR, 3.0; 95% CI, 0.76-11.9). However, point-of-care multiplex PCR testing was not associated with a significant decrease in the rate of untargeted antibiotic therapy compared with routine care (RR, 0.92; 95% CI, 0.76-1.12).

This study was limited by the increased number of patients in the control group who were actively tested for respiratory syncytial virus and influenza compared with those in the intervention group. These results also may not be generalizable in settings with different antibiotic prescription guidelines.

“Systematic testing for respiratory pathogens in the ED appears to have a limited impact on clinical decision-making regarding [antibiotic] therapy for acutely ill children,” the researchers concluded.

Reference

Mattila S, Paalanne N, Honkila M, Pokka T, Tapiainen T. Effect of point-of-care testing for respiratory pathogens on antibiotic use in children: A randomized clinical trial. JAMA Netw Open. Published online June 1, 2022. doi:10.1001/jamanetworkopen.2022.16162