Usefulness of rapid molecular tests in pediatric respiratory tract infections

Camilla Gizzi,Maria Vittoria De Sandro ,Matteo Calafatti,Simona Nardi,Giovanna Solito,Lorella Carolis ,Roberta Iannini

doi:10.1186/s13052-022-01200-1

Abstract

ObjectiveTo evaluate the role and the advantages of nasopharyngeal swabs in the detection of Influenza A and B viruses and Respiratory syncytial virus through a rapid test based upon a nucleic acid amplification reaction in order to avoid improper antibiotics use.DesignCase-control retrospective study.SettingEmergency Room of “Sandro Pertini” General Hospital, Rome, Italy.ParticipantsChildren (< 14 years old) who consecutively arrived in the Emergency Department (ED) for respiratory tract infections, without obvious signs of bacterial respiratory tract infections and other comorbidities, in the maximal seasonal incidence period of November-to-March of every year between 2016 and 2020.MethodsMedical records of children included in the study were retrospectively examined. Children were subdivided according to the following intervals: 2016–2017 and 2017–2018 (Group 1), 2018–2019 and 2019–2020 (Group 2). Children in Group 2 undertook a nasopharyngeal swab, while those in Group 1 did not undergo any specific diagnostic test.Primary outcomeAvoidance of improper antibiotics administration.ResultsA total of 386 children were included in the study: 174 in Group 1, 212 in Group 2. The Odd Ratio (OR) of prescribing an antibiotic in the groups of children not being swabbed compared to those of children undertaking a swab was 9.21 (CI95% 5.6–15.2, p < 0.001). The overall percentage of hospitalizations, both in the short observation unit or in the pediatric unit, did not differ between the two groups.ConclusionsNasopharyngeal swabs for the detection of Influenza A and B viruses and Respiratory syncytial virus proved to be a useful means to a correct and timely diagnosis and allowed for a significant reduction in the prescription of antibiotic therapy.Trial registrationRetrospectively registered.

Highlights

Respiratory tract infections (RTIs) are widespread in the community and commonly occur during the first decade of life
Lorella Carolis gave substantial contributions to conception of the manuscript and to acquisition and interpretation of data; she helped in taking the molecular tests to patients; she revised the manuscript critically for important intellectual content and gave her approval of the final version to be published; she agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
Roberta Iannini gave substantial contributions to conception of the manuscript and to acquisition and interpretation of data; she helped in taking the molecular tests to patients; she revised the manuscript critically for important intellectual content and gave her approval of the final version to be published; she agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Summary

Introduction

Respiratory tract infections (RTIs) are widespread in the community and commonly occur during the first decade of life. Preschoolers and school-aged children come across, on average, three to ten febrile infections per year [1]. The most common causes of RTIs are viral (e.g., Rhinovirus, Influenza and Parainfluenza viruses, Respiratory syncytial virus, etc.) or bacterial (e.g., Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, etc.). The differential diagnosis between the two infective etiologies (viral vs bacterial) is often challenging as those two share many common symptoms: fever, cough, respiratory distress, pharyngitis, rhinorrhea, earache, headache, swollen regional lymph nodes, malaise and asthenia. RTIs require careful pediatric evaluation and while the use of antibiotics is justified in the setting of a bacterial infection, the same therapy is not indicated in the presence of a viral infection. A correct differential diagnosis is essential to establish an adequate treatment plan

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