Infectious Disease

Rapid tests for respiratory pathogens in pediatric ED do not reduce the use of antibiotics

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Disclosure:
Rao reports that he has received grants from GlaxoSmithKline outside of the study. Please refer to the study for all relevant financial information from the other authors.

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The use of rapid airway pathogen testing for flu-like illnesses in a pediatric emergency room did not reduce the prescription of antibiotics, according to results from a randomized clinical trial reported on the JAMA Network Open.

Suchitra Rao, MD, MBBS, MSCS, Associate Professor of Pediatrics at the University of Colorado School of Medicine and a specialist in pediatric infectious diseases at Children’s Hospital Colorado, and colleagues conducted a single center randomized clinical trial of children aged 1 month to 18 years who were infected with influenza presented to the emergency room. like illness (ILI) from December 1st, 2018 to November 30th, 2019.

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They excluded children if they had respiratory symptoms for more than 14 days and were only seen by nurses during visits. The study included more than 900 children, each of whom received a nasopharyngeal swab for rapid respiratory tract testing (RRP) and were randomly assigned at a 1: 1 ratio to an intervention group (n = 452) to receive the results of the RRP tests were performed on treating clinicians or a control group (n = 456) in which the clinicians received no test results.

Positive RRP tests were obtained in 795 out of 931 visits included (85%). The most frequently detected pathogens were enterovirus / rhinovirus (n = 295), influenza (n = 180), respiratory syncytial virus (n = 162) and adenovirus (n = 115).

According to the primary intention-to-treat (ITT) analysis, children in the intervention group whose clinicians knew the results of the RRP test were more likely to receive antibiotics than children in the control group (RR = 1.31; 95% CI 1.03-1.68.). ), “With no significant difference in antiviral drug prescription, length of ED stay, subsequent ED visits, and hospitalization rates,” wrote Rao and colleagues. In addition, those in the intervention group were more likely to have a diagnosis for which antibiotics were indicated (risk difference = 8.6; 95% CI 3.2–13.8).

According to adjusted ITT analyzes, children in the intervention group were more likely to receive suitable antiviral drugs (RR = 2.5; 95% CI 1.5-4.2), and longer stays in the emergency room (RR = 1.6; 95% CI 1.5-1.7.). ) and have higher hospitalization rates (RR = 2; 95% CI, 1.5-2.7) compared to those in the control group.

The prescription of antibiotics was not significant in the adjusted analysis (RR = 1.1; 95% CI, 0.9-1.3).

“The greatest impact on clinicians’ clinical decision-making has been the appropriate antiviral use in children based on influenza test results, which supports the potential utility of rapid molecular influenza testing in this setting,” the authors write.

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