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The Effect of Rapid Respiratory Viral Diagnostic Testing on Antibiotic Use in a Children's Hospital
Carrie L. Byington, MD;
Heidi Castillo, MD;
Kris Gerber, MT;
Judy A. Daly, PhD;
Laurie A. Brimley, MS;
Susan Adams, RN;
John C. Christenson, MD;
Andrew T. Pavia, MD
Arch Pediatr Adolesc Med. 2002;156:1230-1234.
Background Acute viral respiratory disease is the most common reason for pediatric hospitalization in the United States. Viral illnesses may be mistaken for bacterial infection, and antibiotic therapy may be prescribed. Overprescribing of antimicrobials for viral illness is a factor contributing to increasing antimicrobial resistance among bacterial pathogens encountered in pediatrics.
Objective To determine if the availability of a rapid diagnostic test for respiratory viruses would affect antibiotic use in a children's hospital.
Design Retrospective medical record review.
Setting A 232-bed urban children's hospital.
Participants All hospitalized infants and children who underwent rapid testing (SimulFluor Respiratory Screen; Chemicon International Inc, Temecula, Calif) for respiratory viruses by direct fluorescent assay (DFA) during 2 successive winter seasons.
Main Outcome Measures Rates of antibiotic prescribing in DFA-positive and DFA-negative patients during the 2 study periods.
Results During the first winter season, DFA-positive patients had fewer days using intravenous antibiotics (2.4 vs 4, P = .04), fewer days using oral antibiotics (0.25 vs 2.5, P = .04), and fewer discharge prescriptions for oral antibiotics (37% vs 52%, P = .02) when compared with DFA-negative patients. Intravenous antibiotics were initiated less often for DFA-positive patients during the second winter season than during the first (26% vs 44%, P = .008).
Conclusions Direct fluorescent assay testing was associated with a decrease in inappropriate antibiotic use. The availability of rapid viral diagnostics is an important tool for decreasing antibiotic prescribing in pediatric patients.
From the Division of Pediatric Infectious Diseases, Departments of Pediatrics (Drs Byington, Castillo, Christenson, and Pavia) and Medicine (Dr Pavia), University of Utah, and the Departments of Clinical Microbiology (Dr Daly and Ms Gerber) and Quality Assurance (Mss Brimley and Adams), Primary Children's Medical Center, Salt Lake City. Dr Christenson is currently with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis.
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