Impact of respiratory pathogens detection by a rapid multiplex PCR assay on the management of community-acquired pneumonia for children at the paediatric emergency department. A randomised controlled trial, the OPTIPAC study.

The pathogen of community-acquired pneumonia (CAP) in children is typically uncertain during initial treatment, leading to systematic empiric antibiotic use. This study investigates if having rapid multiplex PCR results in the emergency department (ED) improves empiric treatment. OPTIPAC, a French multicentre study (2016-2018), enrolled patients consulting for CAP at the paediatric ED in 11 centres. Patients were randomised to either receive a multiplex PCR test plus usual care or usual care alone and followed for 15 days. The primary outcome was the appropriateness of initial antimicrobial management, determined by a blinded committee. Of the 499 randomised patients, 248 were tested with the multiplex PCR. Appropriateness of the antibiotic treatment was higher in the PCR group (168/245, 68.6% vs 120/249, 48.2%; RR 1.42 [1.22-1.66], P<0.0001), chiefly by reducing unnecessary antibiotics in viral pneumonia (RR 3.29 [2.20-4.90]). No adverse events were identified. The multiplex PCR assay result at the ED improves paediatric CAP's antimicrobial stewardship, by both reducing antibiotic prescriptions and enhancing treatment appropriateness.

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Copyright © 2024 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of interest All the co-authors of this study deny having any conflict of interest regarding the matter of this trial. The authors declare that they have not received any support from the industry in the past three years. The bioMérieux company, which manufactures the FILMARRAY™ kits, was not involved in the planning, execution, analysis, or interpretation of the study; all the reagents were granted by the research program.