Rapid respiratory pathogen testing in pediatric ED does not reduce antibiotic use

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disclosures:
Rao reports that he has received grants from GlaxoSmithKline outside of the research. See the study for all relevant financial disclosures from other authors.

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Using rapid respiratory pathogen testing for influenza-like illness in a pediatric emergency room did not reduce antibiotic prescribing, according to findings from a randomized clinical trial reported in JAMA Network Open.

Suchitra Rao, MD, MBBS, MSCS, an associate professor of pediatrics at the University of Colorado School of Medicine and a pediatric infectious disease specialist at Children’s Hospital Colorado, and colleagues conducted a single-center, randomized clinical trial in children 1 month to 18 years of age presenting to the emergency room with influenza – such as illness (ILI) from December 1, 2018 to November 30, 2019.

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They excluded children if they had had respiratory symptoms for more than 14 days and were seen during nurse-only visits. The study 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 from the tests.

Positive RRP tests were received for 795 of the 931 recorded 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 analysis (ITT analysis), children in the intervention group whose clinicians were aware of the RRP test results were more likely to receive antibiotics than children in the control group (RR = 1.31; 95% BI, 1.03-1.68). ), “with no significant difference in antiviral drug prescribing, ED length of stay, subsequent ED visits, and hospitalizations,” Rao and colleagues wrote. In addition, 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), had longer ED stays (RR = 1 .6, 95% CI, 1.5-1.7). ) and have higher hospital admissions (RR = 2; 95% CI, 1.5-2.7), compared to 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 the appropriate use of pediatric antivirals based on the results of flu testing, supporting the potential benefit of rapid molecular flu testing in this setting,” the authors wrote.

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