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Antibiotic Use in Hospitalized Children with Respiratory Viruses Detected by Multiplex Polymerase Chain Reaction

Goriacko, Pavel PharmD, MPH; Saiman, Lisa MD, MPH; Zachariah, Philip MD, MS
The Pediatric Infectious Disease Journal: Post Acceptance: September 05, 2017
doi: 10.1097/INF.0000000000001775
Antimicrobial Reports: PDF Only

Background:

Multiplex polymerase chain reaction (mPCR) based methods are increasingly used to detect respiratory pathogens in children. While rapid identification of viruses has been shown to reduce antibiotic use, the impact of detecting specific viruses on antibiotic utilization has not been ascertained. This study compared antibiotic utilization among hospitalized children who tested positive for different respiratory viruses at admission.

Methods:

A single-center study of hospitalized children under 21 years of age who tested positive at admission for at least one respiratory virus by mPCR from October 1st 2012 to October 1st 2015 was performed. Multivariable logistic regression was used to determine the association of testing positive for specific viruses with the use of antibiotics for ≥ 2 days, adjusted for demographic and clinical characteristics.

Results:

The study included 1416 patients with a median age of 2.1 years (IQR 0.6-6.2 years). Patients positive for influenza (OR 2.0, 95% CI 1.1 - 3.4) and human metapneumovirus (HMPV) (OR 2.0, 95% CI 1.1-3.7) were more likely to receive ≥ 2 days of treatment compared to patients positive for respiratory syncytial virus (RSV). Other variables affecting prolonged use of antibiotics included respiratory support, primary non-respiratory diagnosis, complex comorbid conditions, and admission to the intensive care unit.

Conclusions:

Providers are more likely to use antibiotics in non-RSV infected patients compared to RSV. These trends likely represent concern about bacterial superinfection and may reflect lack of familiarity with these pathogens.

Authors have no conflicts of interest to disclose.

Corresponding author: Pavel Goriacko, PharmD, MPH, Clinical Pharmacy Manager, Critical Care, Department of Pharmacy, Montefiore Medical Center , Phone: 718.920.9775 Email: pgoriack@montefiore.org

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