Background: Viral respiratory infections are a leading cause of hospitalization and death in children. Despite the viral origin antibiotics are often prescribed. In this study, we report the impact of implementing an in house TaqMan® Array Card (TAC) based respiratory panel in the diagnostic care of pediatric inpatients. We examined if TAC implementation was associated with consequent changes in clinical management: awareness of viral pathogens possibly causing severe LRTI's, ordering molecular based tests instead of culture, and reduction of antibiotic use.
Methods: Pediatric inpatients (0–5 year) were identified between January 1st, 2013 and December 31st, 2014 for whom a respiratory TAC analysis was ordered within 24 hours of admission. Patients with respiratory symptoms, were selected by All Patient Refined Diagnosis Related Group (APR-DRG). The TAC panel (implemented January, 2013) included testing for following 34 respiratory pathogens: influenza A virus (H1, H3, H7), influenza B virus, RSV A, RSV B, parainfluenza virus 1 to 4, adenovirus, rhinovirus, enterovirus, hMPV, coronavirus (229E, HKU1, OC43, NL63, MERS), bocavirus, cytomegalovirus, parechovirus, mumps virus, measles virus, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, Bordetella pertussis, Bordetella parapertussis, Bordetella holmesii/bronchiseptica, Coxiella burnetii, Legionella pneumophila, Pneumocystis jiroveccii, and Aspergillus species.
Results: During the study period, 875 pediatric patients were admitted among who 298 (34.1%) were diagnosed with respiratory pathology and received antibiotic therapy (180 in 2013, 118 in 2014). In 2013, 192 tests of different respiratory episodes were performed. Based on the results of this novel test, clinicians only prescribed antibiotics for 63 episodes (32.8%) reflecting a possible reduction of antibiotic use for 129 patients. One year after implementation, 164 tests of different infectious episodes were conducted, reflecting a possible slight overconsumption linked to the introduction period. However, only 69 results (42%) led to antibiotic use. 95 (58%) results did not evoke antibiotics prescription.
Conclusion: A change in clinical management based on TAC results was observed. Awareness of potential viral pathogens causing LRTI's resulted in reduction of antibiotic use. Implementation of respiratory TAC had following potential benefits: early, highly sensitive and specific adequate broad pathogen diagnosis, improved management of the individual child, reduced selection of resistant bacteria, considering co- infections, treatment adaptation options, transmission prevention opportunity, expanding view on respiratory epidemiology, reduced need for further laboratory evaluation, and possibly reducing the overall costs of care. In conclusion, the use of respiratory TAC guides clinical decision making and reduces inadequate antibiotic use for viral infections.