2622. Multiplex Polymerase Chain Reaction (PCR) Panels in Pediatric Hospital Care: New Insights into Factors Driving Antimicrobial Use

Abstract

BackgroundMultiplex PCR panels are diagnostic tools that first became available in 2011. They have rapid turnaround time and excellent sensitivity and specificity for a wide spectrum of microbial targets. However, it remains controversial whether its widespread use leads to optimal use of antimicrobials. We aimed to determine whether use of these tests was associated with appropriate antimicrobial therapy (AAT).MethodsWe conducted a single-center, retrospective study of hospitalized pediatric patients from 2015 to 2018 looking at 4 different respiratory panels and 1 meningoencephalitis panel (MEP). We analyzed test results and compared them to antimicrobial treatment. Using logistic regression, we analyzed the clinical and laboratory factors associated with AAT (defined as directed antimicrobial therapy based on clinical assessment and tests results).ResultsThere were 1,002 encounters in 951 patients. Mean length of stay was 7 days. 53.2% encounters had intensive care unit (ICU) admission. 77.1% of respiratory panels and 17.3% of MEP were positive. Co-detection in respiratory samples was 44.2%. Enterovirus was the most common virus detected while H. influenza was the most frequent bacteria. Respiratory Syncytial Virus was commonly detected with bacteria when compared with other common viruses. 13.4% patients were intubated, concordance with sputum culture was 63%. Patients admitted to the floor were more likely to have AAT than ICU patients (82.5% vs. 71.7%). ICU admission increased the odds of unnecessary antimicrobials (OR 1.6; 95% CI 1.1–2.5). Positive result from a comprehensive respiratory panel (bacteria + virus) decreased the odds of AAT (odds ratio: 0.4, 95% CI 0.3–0.8). Age, season, comorbidity, and intubation were not significantly associated with AAT. Only 0.5% of blood cultures in patients tested for respiratory infection were positive (3/579).ConclusionWe present new insights into factors driving antimicrobial use in pediatric hospital care. ICU admission was significantly associated with unnecessary antimicrobial use after adjusting for clinical findings and diagnostics. Frequently PCR results were not acted upon or caused additional use of antimicrobials. Further investigation is warranted to understand factors influencing antimicrobial use in pediatric care. Disclosures All authors: No reported disclosures.