Clinical impact of rapid molecular detection of respiratory pathogens in patients with acute respiratory infection

• Published in: Journal of clinical virology 2018-11, Vol.108, p.90-95
• Main Authors: Echavarría, M., Marcone, D.N., Querci, M., Seoane, A., Ypas, M., Videla, C., O'Farrell, C., Vidaurreta, S., Ekstrom, J., Carballal, G.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Aged; Antibiotics; Child; Child, Preschool; Clinical impact; Emergency Service, Hospital - statistics & numerical data; Female; FilmArray; Fluorescent Antibody Technique; Humans; Inappropriate Prescribing - prevention & control; Infant; Male; Middle Aged; Multiplex PCR; Multiplex Polymerase Chain Reaction; Oligonucleotide Array Sequence Analysis; Oseltamivir; Oseltamivir - therapeutic use; Prospective Studies; Respiratory infections; Respiratory Tract Infections - diagnosis; Respiratory Tract Infections - virology; Virus Diseases - diagnosis; Virus Diseases - drug therapy; Viruses - classification; Viruses - isolation & purification; Young Adult
• ISSN: 1386-6532; 1873-5967
• DOI: 10.1016/j.jcv.2018.09.009

•Diagnosis with FilmArray-RP was associated with changes in medical management.•Accurate and rapid diagnosis decreased antibiotic use and complementary studies, and improved oseltamivir use.•The multiplex PCR respiratory panel permitted a high viral detection rate not only in children but in adults. Acute respiratory infections (ARI) are a leading cause of morbidity and mortality worldwide. There is a need to demonstrate the clinical impact of using the new, rapid and sensitive molecular assays in prospectively designed studies. To study the impact on medical management of a rapid molecular assay in patients with respiratory infections. A prospective, randomized, non-blinded study was performed in patients presenting to the Emergency Department during two respiratory seasons (2016–2017). Diagnosis was performed by FilmArray Respiratory Panel (FilmArray-RP) or by immunofluorescence assay (IFA). A total of 432 patients (156 children and 276 adults) were analyzed. Diagnosis with FilmArray-RP was associated with significant changes in medical management including withholding antibiotic prescriptions (OR:15.52, 95%CI:1.99–120.83 in adults and OR:12.23, 95%CI:1.56–96.09 in children), and reduction in complementary studies in children (OR:9.64, 95%CI:2.13–43.63) compared to IFA. Decrease in oseltamivir prescriptions was significantly higher in adults in the FilmArray-RP group (p = 0.042; OR:1.19, 95%CI:0.51-2.79) compared to adults managed with IFA. Diagnostic yield was significantly higher by FilmArray-RP (81%) than by IFA (31%)(p