Test rapido per patogeni respiratori e prescrizione di antibiotici in Pronto Soccorso nel bambino con patologia respiratoria acuta

Abstract

Rapid respiratory pathogen testing and antibiotic prescribing in ED in children with acute respiratory illness There is high usage of antibiotics in the emergency department (ED) for children with acute respiratory illnesses. Studies have reported decreased antibiotic use among inpatients with rapid respiratory pathogen (RRP) testing. The present study aims to determine whether ED RRP testing leads to decreased antibiotic use and health care use among children with influenza-like illness (ILI) in an ED. A randomized clinical trial among children aged 1 to 18 years presenting to an ED with ILI from December 2018 to November 2019 was conducted. Patients were randomized in an intervention group or a control group (results not given, routine clinical care). Intention-to-treat analyses and modified intention-to-treat (clinician knows results) analyses were conducted. Primary outcome was antibiotic prescribing whereas influenza antiviral prescribing, ED length of stay, hospital admission, and recurrent health care visits were the secondary outcomes. Among 931 ED visits, a total of 795 RRP test results (85%) were positive. In the intention-to-treat intervention group, children were more likely to receive antibiotics, with no significant differences in antiviral prescribing, medical visits, and hospitalization. In inverse propensity-weighted modified intention-to-treat analyses, children with test results known were more likely to receive antivirals and be hospitalized; there was no significant difference in antibiotic prescribing. The use of RRP testing in the ED for ILI did not decrease antibiotic prescribing in this randomized clinical trial. There is a limited role for RRP pathogen testing in children in this setting.