Impact of Multiplex Polymerase Chain Reaction Testing for Respiratory Pathogen Detection in Pediatric Patients

Abstract

BackgroundViral pathogens are a leading cause of respiratory infection in the pediatric population. In August 2015, Williamson Medical Center implemented a respiratory panel (RP) that enables rapid detection of 20 common pathogens by multiplex polymerase chain reaction. Utilization of the RP was reviewed to assess the impact of the test on healthcare and antimicrobial utilization.MethodsA retrospective chart review was conducted of all patients aged 0 to 17 years with RP specimens collected August 2015 through December 2016. An evaluation of the impact of RP results was completed through review of duration or change in antimicrobial therapy, change in patient management, and avoidance of further workup, antimicrobial therapy, or hospital admission. A subgroup analysis was performed for patients less than 60 days of age.ResultsTwo hundred and ninety-five pediatric patients had a RP specimen collected during the evaluation timeframe. Ninety-six percent of tests were appropriate based on symptoms and 49% of RP results changed patient management (Table 1). RP result did not change management in any patients greater than 10 years of age. A pathogen was identified in 66% of specimens, with rhinovirus/enterovirus (53.6%) and respiratory syncytial virus (20.5%) being the most common viruses isolated. The use of the RP was highest in the months of August through December, with viral pathogen isolation being highest in these months as well. In patients less than 60 days of age (n = 40), the RP result changed management in 22 (55%) cases, including 3 avoided admissions, 12 avoided antibiotic courses, and 7 avoided lumbar punctures.ConclusionThe use of a RP was beneficial in this pediatric population to decrease hospital admissions, avoid further unnecessary procedures, avoid unnecessary antibiotic therapy, decrease duration of antibiotics and target antimicrobial therapy. Further consideration should be given to implement an algorithm for use.Disclosures M. F. Williams, BioFire Diagnostics: Consultant, Speaker honorarium; Joint Commission Resources: Consultant, Speaker honorariumTable 1:Respiratory Panel Collection 0–17 Years of AgeSamples Collected295Test Appropriate Based on Symptoms284 (96%)Pathogen Detected196 (66%)Result Changed Management145 (49%)Avoid Admission44Reduce Further Procedures/Workup33Avoid Antibiotics89Narrow/Decrease Antibiotic Duration20Target Antimicrobial Therapy14