References
A clinical study of the benefits and effectiveness of a respiratory viral panel PCR study in children presenting with respiratory tract infections
Abstract
Introduction
Respiratory illnesses account for more than half of paediatric diseases and it is often difficult to differentiate viral and bacterial agents by clinical assessment, leading to unnecessary investigations and interventions including hospitalisation and use of antibiotics. A respiratory virus panel (RVP) multiplex polymerase chain reaction (PCR) test can identify the pathogen rapidly with specificity. The objective of this study was to explore the characteristics and outcomes of children who had RVP PCR and to identify its impact on the use of antibiotics, hospitalisation, and revisit and readmission rates.
Methods
The medical records of 100 children under 18 years old in one hospital in Dubai who had an RVP PCR test in December 2019 were reviewed to investigate the type of pathogen identified as well as hospitalisation and antibiotic use rates.
Results
Out of 100 children, 85 had a positive RVP result. Rhino/enterovirus was the single most common virus (28.8%) identified. There was a hospital admission rate of 9%, as one baby in the neonatal intensive care unit had an RVP PCR test during the study period. This baby was excluded during the statistical analysis as the baby was not an outpatient at the time of testing. Seven children received antibiotics. Of the 87 patients sent home, 10 (11.5%) only received antibiotics. Overall, 14 patients revisited the hospital within 1 week. There was no antibiotic use at follow up and the readmission rate was 0%.
Conclusions
This study illustrates that a positive RVP PCR result leads to beneficial outcomes such as low rates of hospitalisation and antibiotic use. With thoughtful clinical correlation, the RVP PCR can be a useful and cost-effective tool for clinical management.
Respiratory illnesses constitute at least half of the paediatric illnesses in any population (BioFire, 2021). Respiratory pathogens cause acute local and systemic disease, with the most severe cases occurring in young children, especially those less than 5 years of age (Monto, 2002; Andrea et al, 2017). Respiratory symptoms include cough, nasal discharge, fever, wheezing and shortness of breath. As a result of the similarity of diseases caused by many viruses and bacteria, diagnosis based on clinical symptoms alone is difficult. Identification of potential causative agents provides data to aid a physician in determining appropriate patient treatment and to direct a public health response for disease containment.
The author's hospital in the United Arab Emirates, has the facility to perform an approved and standardised respiratory viral panel polymerase chain reaction [PCR] test (real-time, nested multiplexed PCR test) designed to simultaneously identify nucleic acids from 23 different viruses and bacteria associated with respiratory tract infection using a single nasopharyngeal swab specimen. A respiratory virus panel (RVP) multiplex PCR test increases the ability to establish specific diagnosis within a wider range of potential pathogens by performing a single test but also increases diagnostic cost significantly (Andrea et al, 2017; BioFire, 2021). Debate exists over the utility and cost-effectiveness of testing for respiratory viruses, as there is currently specific antiviral therapy available only for influenza virus in the form of oseltamivir (Brendish et al, 2017; Landoll et al, 2017). A positive RVP result could potentially decrease antibiotic use and the need for hospitalisation when results are readily available. The objective of this study was to explore the characteristics and outcomes of children who had RVP and to identify its impact, if any, on the use of antibiotics, hospitalisation, revisit, and readmission rates.
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