Impact of PCR for respiratory viruses on antibiotic use: theory and practice

Alma van de Pol (1) , Tom Fw Wolfs (2) , Carline Tacke (2) , Cuno Uiterwaal (3) , Johannes Forster (4) , Anton M van Loon (5) , Jan Ll Kimpen (6) , John Rossen (5, 7) , Nicolaas Jansen (8)

1 Pediatric Critical Care
2 Pediatric Infectious Diseases
3 Julius Centre for Health Sciences and Primary Care
4 Children's Hospital
5 Virology
6 University Medical Center [Utrecht]
7 Laboratory of Medical Microbiology and Immunology
8 Pediatric Critical Care

Rationale for the study Real-time PCR for respiratory viruses is more sensitive, yet more expensive, than conventionally used direct immunofluorescence (DIF). We determined the impact of real-time PCR, additional to DIF, on antibiotic prescription in ventilated children with lower respiratory tract infection (LRTI) at admission to the pediatric intensive care unit (PICU). Methods First, a survey study was performed. Subsequently, in a prospective real-life study, children (≤5 years) with LRTI were tested at admission by DIF and PCR. Positive DIF results were reported at the end of the first working-day. PICU physicians reported antibiotic treatment on the second working-day. After informing them of the PCR result antibiotic treatment was reevaluated. Results The survey study (94 respondents) showed that PCR decreased antibiotic use (p<0.001). In the prospective real-life study 38 children were included, of which 19 (50%) were DIF positive. Of the 19 DIF-negative patients 12 (63%) were treated with antibiotics before revealing the PCR result; the PCR test was positive in 9 out of 12. Revealing PCR results did not alter antibiotic treatment. In 7 DIF-negative patients not given antibiotics, the PCR test was positive. Conclusion In contrast to their responses to the survey study, in real-life PICU physicians did not let their antibiotic prescription be influenced by respiratory real-time PCR in children ventilated for LRTI.

Mots clés: Medicine

Alma van de Pol, Tom Fw Wolfs, Carline Tacke, Cuno Uiterwaal, Johannes Forster, et al.. Impact of PCR for respiratory viruses on antibiotic use: theory and practice. Pediatric Pulmonology, 2010, ⟨10.1002/ppul.21385⟩. ⟨hal-00604879⟩