Viral Identification Using Multiplex Polymerase Chain Reaction Testing Does Not Reduce Antibiotic Prescribing in Paediatric Intensive Care Units
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Setting
2.2. Population
2.3. Data Collection and Outcome Measures
2.4. Definition of Bacterial Infection
2.5. Statistical Analysis
3. Results
3.1. Characteristics of the Study Population
3.2. Indication and Epidemiology of FilmArray® Respiratory Panel Tests
3.3. Bacterial Pulmonary Infection
3.4. Impact of Viral Identification on Antibiotic Therapy Management and Factors Associated with the Absence of Antibiotics after the Test
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | N = 544 n (%) Median (IQR) |
---|---|
Age (month) | 7 (2–31) |
Sex (male) | 306 (56%) |
PIM2 score | 1 (1–5) |
PELOD-2 score | 1 (0–3) |
Comorbidity | 370 (68%) |
Prematurity | 115 (21%) |
immunodeficiency | 24 (4%) |
Heart disease | 88 (16%) |
Pulmonary disease | 121 (22%) |
Encephalopathy | 95 (17%) |
Sickle cell disease | 29 (5%) |
History of LRTI | 123 (23%) |
Recent hospitalisation within 6 months | 129 (24%) |
Reason for hospitalization | |
Respiratory failure | 379 (70%) |
Hemodynamic failure | 44 (8%) |
Metabolic abnormality | 25 (5%) |
Neurological failure | 70 (13%) |
Faintness | 38 (7%) |
Duration of Ventilation Support (days) | 3 (0–9) |
Length of stay (PICU) (days) | 5 (3–12) |
Death | 34 (6%) |
FARPT + (n = 383) | FARPT − (n = 161) | ||
---|---|---|---|
n (%) Median (IQR) | n (%) Median (IQR) | p-Value | |
Baseline characteristics | |||
Age (month) | 7 (2–22) | 6 (1–71) | <0.001 |
Score PIM-2 (%) | 1 (1–4) | 4 (1–10) | <0.001 |
Score PELOD-2 (%) | 0 (0–3) | 2 (0–4) | <0.001 |
Comorbidity | 250 (65%) | 120 (74%) | 0.04 |
Prematurity | 96 (25%) | 19 (12%) | <0.001 |
immunodeficiency | 11 (3%) | 13 (8%) | 0.01 |
Heart disease | 57 (15%) | 31 (19%) | 0.26 |
Pulmonary disease | 94 (25%) | 27 (17%) | 0.06 |
Encephalopathy | 59 (15%) | 36 (22%) | 0.07 |
Sickle cell disease | 12 (3%) | 17 (11%) | <0.001 |
History of LRTI | 80 (21%) | 43 (26%) | 0.17 |
Recent hospitalisation within 6 months | 286 (75%) | 93 (58%) | <0.01 |
Reason for hospitalization | |||
Respiratory failure | 286 (75%) | 93 (58%) | <0.001 |
Hemodynamic failure | 31 (8%) | 13 (8%) | 0.99 |
Neurological failure | 50 (13%) | 20 (12%) | 0.95 |
Metabolic abnormality | 17 (4%) | 8 (5%) | 0.92 |
Post-operative | 16 (4%) | 11 (7%) | 0.28 |
Faintness | 23 (6%) | 15 (9%) | 0.23 |
Symptoms and treatments before testing | |||
Length of fever (days) | 1 (0–1) | 1 (0–2) | <0.001 |
No fever | 111 (29%) | 43 (27%) | 0.65 |
1 day | 186 (49%) | 50 (31%) | <0.001 |
2 days | 85 (22%) | 68 (42%) | <0.001 |
No antibiotics | 231 (60%) | 65 (40%) | <0.001 |
Duration of antibiotics (days) | 0 (0–1) | 1 (0–2) | <0.001 |
1 day | 89 (23%) | 36 (22%) | 0.91 |
2 days | 63 (17%) | 60 (37%) | <0.001 |
IMV | 69 (18%) | 61 (39%) | <0.001 |
NIV | 216 (56%) | 94 (58%) | 0.74 |
HFOT | 37 (10%) | 8 (5%) | 0.1 |
Oxygen glasses | 116 (30%) | 29 (18%) | <0.01 |
Fluid resuscitation | 86 (22%) | 40 (25%) | 0.62 |
Presence of vasoactive drugs | 23 (6%) | 13 (8%) | 0.15 |
Reason for testing | |||
ACS | 5 (1%) | 14 (9%) | <0.001 |
Bronchiolitis | 119 (31%) | 12 (7%) | <0.001 |
Acute asthma | 59 (15%) | 6 (4%) | <0.001 |
CAP | 61 (16%) | 23 (14%) | 0.72 |
HAP | 53 (14%) | 52 (32%) | <0.001 |
Faintness | 14 (4%) | 15 (9%) | 0.01 |
Meningoencephalitis | 27 (7%) | 12 (8%) | 1 |
Fever and complementary exams when FARPT was performed | |||
Fever within 6 h | 245 (65%) | 101 (64%) | 0.86 |
Radiological abnormality | 268 (70%) | 114 (71%) | 0.93 |
Radiological focus | 47 (16%) | 14 (12%) | 0.03 |
CRP (mg/L) | 19 (0–61) | 16 (0–64) | 0.85 |
WBC (/mm3) | 12,810 (8600–17,600) | 12,960 (7993–19,760) | 0.65 |
Evolution post-test | |||
Duration of antibiotics (days) | 0 (0–1) | 0 (0–2) | 0.68 |
Duration of hospitalization (days) | 5 (3–9) | 8 (3–20) | <0.001 |
Duration of ventilation support (days) | 3 (0–6) | 6 (1–19) | <0.001 |
Presence of vasoactive drugs | 28 (7%) | 16 (10%) | 0.39 |
Death | 23 (6%) | 11 (7%) | 0.76 |
Bacterial Infection (n = 96) | No Bacterial Infection (n = 287) | ||
---|---|---|---|
n (%) Median (IQR) | n (%) Median (IQR) | p-Value | |
Baseline characteristics | |||
Age (month) | 9 (2–54) | 7 (2–18) | 0.01 |
Comorbidity | 70 (73%) | 180 (62%) | 0.09 |
Prematurity | 28 (29%) | 68 (24%) | 0.35 |
immunodeficiency | 2 (2%) | 9 (3%) | 0.74 |
Heart disease | 18 (19%) | 39 (14%) | 0.29 |
Pulmonary disease | 24 (25%) | 70 (24%) | 1 |
Encephalopathy | 21 (22%) | 38 (13%) | 0.06 |
Sickle cell disease | 4 (4%) | 8 (3%) | 0.50 |
History of LRTI | 21 (22%) | 59 (21%) | 0.89 |
Recent hospitalisation within 6 months | 19 (20%) | 59 (21%) | 0.99 |
Reason for testing | |||
ACS | 3 (3%) | 2 (<1%) | 0.10 |
Bronchiolitis | 20 (21%) | 99 (18%) | 0.02 |
Acute asthma | 10 (11%) | 49 (9%) | 0.16 |
CAP | 36 (38%) | 25 (5%) | <0.001 |
HAP | 17 (18%) | 36 (7%) | 0.27 |
Faintness | 1 (1%) | 13 (2%) | 0.20 |
Meningoencephalitis | 2 (2%) | 25 (5%) | 0.04 |
Viral identification | |||
RSV | 24 (25%) | 82 (29%) | 0.58 |
HRV | 47 (49%) | 168 (58%) | 0.13 |
Adenovirus | 14 (14%) | 41 (14%) | 1 |
Metapneumovirus | 10 (10%) | 15 (5%) | 0.12 |
Coronavirus | 7 (7%) | 17 (6%) | 0.92 |
Influenza | 9 (9%) | 17 (6%) | 0.44 |
Parainfluenza | 16 (17%) | 32 (11%) | 0.22 |
Fever and complementary exams | |||
Fever within 6 h | 73 (78%) | 172 (61%) | <0.01 |
Radiological abnormality | 88 (88%) | 180 (37%) | <0.001 |
CRP (mg/L) | 61 (13–109) | 14 (0–36) | <0.001 |
WBC (/mm3) | 13,100 (7403–20,650) | 12,710 (9030–16,940) | 0.74 |
Evolution | |||
Duration of hospitalization (days) | 8 (5–16) | 4 (3–6) | <0.001 |
Duration of ventilation support (days) | 6 (3–12) | 2 (0–5) | <0.001 |
Death | 9 (9%) | 14 (5%) | 0.17 |
Univariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|
OR a Adjusted (CI 95%) | p-Value | OR b Adjusted (CI 95%) | p-Value | |
Viral identification | 0.56 (0.35–0.89) | 0.01 | 0.31 (0.15–0.65) | <0.01 |
RSV | 1.20 (0.67–2.14) | 0.54 | ||
HRV | 1.41 (0.86–2.33) | 0.18 | ||
Adenovirus | 1.10 (0.55–2.22) | 0.78 | ||
Metapneumovirus | 0.42 (0.16–1.09) | 0.07 | ||
Coronavirus | 1.53 (0.56–4.19) | 0.41 | ||
Influenza | 0.78 (0.31–1.99) | 0.60 | ||
Parainfluenza | 1.00 (0.48–2.08) | 0.99 | ||
Antibiotics before test | 0.11 (0.07–0.17) | <0.001 | ||
Baseline characteristics | ||||
Age | 0.88 (0.83–0.92) | <0.001 | 0.91 (0.83–0.99) | 0.02 |
Comorbidity | 0.43 (0.27–0.70) | <0.001 | ||
Prematurity | 0.75 (0.45–1.24) | 0.26 | ||
immunodeficiency | 0.47 (0.19–1,16) | 0.11 | ||
Heart disease | 0.78 (0.47–1.67) | 0.39 | ||
Pulmonary disease | 0.62 (0.38–1.01) | 0.06 | ||
Encephalopathy | 0.70 (0.41–1.20) | 0.20 | ||
Sickle cell disease | 0.24 (0.09–0.59) | <0.01 | ||
History of LRTI | 0.54 (0.34–0.88) | 0.01 | ||
Recent hospitalisation within 6 months | 0.67 (0.42–1.08) | 0.10 | ||
Reason for testing | ||||
Bronchiolitis | 1.65 (0.94–2.91) | 0.08 | ||
Acute asthma | 1.27 (0.61–2.67) | 0.52 | ||
CAP | 0.27 (0.15–0.46) | <0.001 | ||
HAP | 0.77 (0.46–1.28) | 0.31 | ||
Faintness | 6.40 (1.44–29.04) | 0.01 | ||
Meningoencephalitis | 10.77 (2.45–47.36) | <0.01 | ||
Fever and complementary exams | ||||
CRP > 18 mg/L | 0.37 (0.22–0.61) | <0.001 | 0.45 (0.25–0.82) | <0.01 |
WBC increased | 0.80 (0.50–1.29) | 0.37 | ||
Presence of fever H-6 | 0.47 (0.29–0.76) | <0.01 | ||
No radiological abnormalities | 6.93 (3.52–13.65) | <0.001 | 5.92 (2.60–13.51) | <0.001 |
Focal infiltrates | 0.04 (0.01–0.10) | <0.001 | ||
Treatments before testing | ||||
IMV | 1.03 (0.64–1.66) | 0.91 | ||
NIV | 0.42 (0.27–0.65) | <0.001 | 0.30 (0.16–0.59) | <0.001 |
Presence of vasoactive drugs | 1.10 (0.52–2.35) | 0.81 |
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Hayotte, A.; Mariani-Kurkdjian, P.; Boizeau, P.; Dauger, S.; Riaud, C.; Lacarra, B.; Bourmaud, A.; Levy, M. Viral Identification Using Multiplex Polymerase Chain Reaction Testing Does Not Reduce Antibiotic Prescribing in Paediatric Intensive Care Units. Microorganisms 2023, 11, 884. https://doi.org/10.3390/microorganisms11040884
Hayotte A, Mariani-Kurkdjian P, Boizeau P, Dauger S, Riaud C, Lacarra B, Bourmaud A, Levy M. Viral Identification Using Multiplex Polymerase Chain Reaction Testing Does Not Reduce Antibiotic Prescribing in Paediatric Intensive Care Units. Microorganisms. 2023; 11(4):884. https://doi.org/10.3390/microorganisms11040884
Chicago/Turabian StyleHayotte, Aurélie, Patricia Mariani-Kurkdjian, Priscilla Boizeau, Stéphane Dauger, Charline Riaud, Boris Lacarra, Aurélie Bourmaud, and Michael Levy. 2023. "Viral Identification Using Multiplex Polymerase Chain Reaction Testing Does Not Reduce Antibiotic Prescribing in Paediatric Intensive Care Units" Microorganisms 11, no. 4: 884. https://doi.org/10.3390/microorganisms11040884