Rapid respiratory pathogen testing in pediatric ED does not reduce antibiotic use
The use of rapid respiratory pathogen testing for influenza-like illness in a pediatric ED did not reduce antibiotic prescribing, according to findings from a randomized clinical trial that were reported in JAMA Network Open.
Suchitra Rao, MD, MBBS, MSCS, associate professor of pediatrics at the University of Colorado School of Medicine and pediatric infectious disease specialist at Children’s Hospital Colorado, and colleagues conducted a single-center, randomized clinical trial among children aged 1 month to 18 years who presented to the ED with influenza-like illness (ILI) from Dec. 1, 2018, to Nov. 30, 2019.
They excluded children if they had experienced respiratory symptoms for more than 14 days and were seen in nurse-only visits. The trial enrolled more than 900 children, each of whom received a nasopharyngeal swab for rapid respiratory pathogen (RRP) testing and were randomly assigned in a 1:1 ratio to either an intervention group (n = 452) in which the results of the RRP tests were given to treating clinicians, or a control group (n = 456) in which clinicians did not receive results of the tests.
Positive RRP tests were received for 795 of 931 included visits (85%). The most commonly detected pathogens were enterovirus/rhinovirus (n = 295), influenza (n = 180), respiratory syncytial virus (n = 162) and adenovirus (n = 115).
According to the primary intention-to-treat (ITT) analysis, children in the intervention group whose clinicians were aware of RRP test results were more likely to receive antibiotics than children in the control (RR = 1.31; 95% CI, 1.03-1.68), “with no significant difference in antiviral prescribing, ED length of stay, subsequent ED visits, and rates of hospitalization,” Rao and colleagues wrote. Additionally, those in the intervention group were more likely to have a diagnosis for which antibiotics would be indicated (risk difference = 8.6; 95% CI, 3.2-13.8).
According to adjusted ITT analyses, children in the intervention group were more likely to receive appropriate antivirals (RR = 2.5; 95% CI, 1.5-4.2), have longer stays in the ED (RR = 1.6; 95% CI, 1.5-1.7) and have higher hospitalization rates (RR = 2; 95% CI, 1.5-2.7), compared with those in the control group.
Antibiotic prescribing was not significant in the adjusted analysis (RR = 1.1; 95% CI, 0.9-1.3).
“The greatest effect on clinicians’ clinical decision-making was appropriate antiviral use for children based on influenza test results, supporting the potential benefit for rapid molecular influenza testing in this setting,” the authors wrote.