The effect of rapid respiratory viral diagnostic testing on antibiotic use in a children's hospital.
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.


METHODS
Retrospective medical record review.


METHODS
A 232-bed urban children's hospital.


METHODS
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.


METHODS
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.
Byington
Carrie L
CL
Department of Pediatric Infectious Diseases, University of Utah, 50 N Medical Drive, Salt Lake City, UT 84132, USA. cbyington@med.utah.edu
Castillo
Heidi
H
Gerber
Kris
K
Daly
Judy A
JA
Brimley
Laurie A
LA
Adams
Susan
S
Christenson
John C
JC
Pavia
Andrew T
AT
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data*; D019085:Fluorescent Antibody Technique, Direct; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008499:Medical Records; D012140:Respiratory Tract Diseases / Q000188:drug therapy* / Q000382:microbiology / Q000821:virology; D012189:Retrospective Studies; D012621:Seasons; D014589:Utah
D000900:Anti-Bacterial Agents