Use of point-of-care molecular tests reduces hospitalization and oseltamivir administration in children presenting with influenza-like illness.
Adolescent
Antiviral Agents
/ therapeutic use
Child
Child, Preschool
Emergency Service, Hospital
/ statistics & numerical data
Female
Health Care Costs
Hospitalization
/ statistics & numerical data
Humans
Immunoassay
/ standards
Infant
Infant, Newborn
Influenza, Human
/ diagnosis
Male
Molecular Diagnostic Techniques
/ methods
Oseltamivir
/ therapeutic use
Point-of-Care Testing
/ standards
Prospective Studies
Virus Diseases
/ diagnosis
antiviral agents
influenza virus
seasonal incidence
Journal
Journal of medical virology
ISSN: 1096-9071
Titre abrégé: J Med Virol
Pays: United States
ID NLM: 7705876
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
14
09
2020
received:
01
05
2020
accepted:
21
09
2020
pubmed:
24
9
2020
medline:
9
10
2021
entrez:
23
9
2020
Statut:
ppublish
Résumé
Influenza is associated with increased morbidity, healthcare costs, hospitalization rates, and mortality in children. Rapid immunochromatography assay (ICA), a test with low sensitivity, is often used as point-of-care (POC) test. Recently, the rapid syndromic molecular test FilmArray has become available. This observational study aims to evaluate whether the use of FilmArray would decrease the use of antivirals and hospitalization rates among children presenting to the emergency room (ER) with influenza-like illness (ILI) symptoms. Nasopharyngeal swabs were prospectively collected from children, aged 0-16 years, presenting with ILI at the ER of a tertiary hospital during the peak endemic period. Patients were allocated to be tested by either FilmArray or ICA. The use of antivirals and hospitalization rates were noted. Logistic regression models were used to investigate the impact of testing methods on decision-making. Overall, 80 children were included (mean age: 5 years). Admissions were more likely to occur if an ICA test was performed (OR, 3.16; 95% CI, 1.01-9.82; p = .046). Oseltamivir administration was more likely among children who had undergone the ICA test (OR, 4.67; 95% CI, 1.06-20.43; p = .041). The implementation of rapid molecular test had no impact on complementary diagnostic testing or antibacterial prescription. The use of FilmArray significantly reduced both hospitalization and oseltamivir administration in children. Further knowledge on the use of POC tests is required to improve current management of children presenting with ILI and decrease associated healthcare costs.
Substances chimiques
Antiviral Agents
0
Oseltamivir
20O93L6F9H
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
3944-3948Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Liu J, Ai H, Xiong Y, et al. Prevalence and correlation of infectious agents in hospitalized children with acute respiratory tract infections in Central China. PLoS One. 2015;10:e0119170.
Harper SA, Bradley JS, Englund JA, et al. Expert panel of the Infectious Diseases Society of America. Seasonal influenza in adults and children-diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:1003-1032.
Jennings LC, Anderson TP, Werno AM, Beynon KA, Murdoch DR. Viral etiology of acute respiratory tract infections in children presenting to hospital: role of polymerase chain reaction and demonstration of multiple infections. Pediatr Infect Dis J. 2004;23:1003-1007.
Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62:e51-e77.
Ali T, Scott N, Kallas W, et al. Detection of influenza antigen with rapid antibody-based tests after intranasal influenza vaccination (FluMist). Clin Infect Dis. 2004;38:760-762.
Chu H, Lofgren ET, Halloran ME, Kuan PF, Hudgens M, Cole SR. Performance of rapid influenza H1N1 diagnostic tests: a meta-analysis. Influenza Other Respir Viruses. 2012;6:80-86.
Vos LM, Bruning AHL, Reitsma JB, et al. Rapid molecular tests for influenza, respiratory syncytial virus, and other respiratory viruses: a systematic review of diagnostic accuracy and clinical impact studies. Clin Infect Dis. 2019;69:1243-1253.
Pettit NN, Matushek S, Charnot-Katsikas A, et al. Comparison of turnaround time and time to oseltamivir discontinuation between two respiratory viral panel testing methodologies. J Med Microbiol. 2015;64:312-313.
CDC. People at high risk for flu complications. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). 27 August 2018. https://www.cdc.gov/flu/highrisk/
FilmArray Respiratory Panel. Information sheet. https://www.biofiredx.com/wp-content/uploads/2016/04/IS-MRKT-PRT-0229-05-FilmArray-Respiratory-Panel-Information-Sheet.pdf. Accessed 22 April 2020.
Loeffelholz MJ, Pong DL, Pyles RB, et al. Comparison of the FilmArray Respiratory Panel and Prodesse real-time PCR assays for detection of respiratory pathogens. J Clin Microbiol. 2011;49:4083-4088.
Busson L, Hallin M, Thomas I, De Foor M, Vandenberg O. Evaluation of 3 rapid influenza diagnostic tests during the 2012-2013 epidemic: influences of subtype and viral load. Diagn Microbiol Infect Dis. 2014;80:287-291.
Mitchell SL, Chang YC, Feemster K, Cárdenas AM. Implementation of a rapid influenza A/B and RSV direct molecular assay improves emergency department oseltamivir use in paediatric patients. J Med Microbiol. 2018;67:358-363.
Echavarría M, Marcone DN, Querci M, et al. Clinical impact of rapid molecular detection of respiratory pathogens in patients with acute respiratory infection. J Clin Virol. 2018;108:90-95.
Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385:1729-1737.
Brendish NJ, Malachira AK, Armstrong L, et al. Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial. Lancet Respir Med. 2017;5:401-411.
Busson L, Bartiaux M, Brahim S, et al. Contribution of the FilmArray respiratory panel in the management of adult and pediatric patients attending the emergency room during 2015-2016 influenza epidemics: an interventional study. Int J Infect Dis. 2019;83:32-39.
Linder JA. Editorial commentary: antibiotics for treatment of acute respiratory tract infections: decreasing benefit, increasing risk, and the irrelevance of antimicrobial resistance. Clin Infect Dis. 2008;47:744-746.
Andrews D, Chetty Y, Cooper BS, et al. Multiplex PCR point of care testing versus routine, laboratory-based testing in the treatment of adults with respiratory tract infections: a quasi-randomised study assessing impact on length of stay and antimicrobial use. BMC Infect Dis. 2017;17:1-11.
Bonner AB, Monroe KW, Talley LI, Klasner AE, Kimberlin DW. Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics. 2003;112:363-367.