title: Potential Utility of Multiplex Amplification Respiratory Viral Panel Testing in the Management of Acute Respiratory Infection in Children: A Retrospective Analysis.
abstract: BACKGROUND
  Multiplex real-time polymerase chain reaction respiratory viral panel (RVP) testing offers enhanced test performance characteristics compared with older testing methods. However, the impact of RVP testing on physician antimicrobial prescription practices remains unclear. Our objective was to assess the potential relationship of RVP testing to physician treatment practices for children hospitalized with acute respiratory illness (ARI).
  
  
  METHODS
  We performed a retrospective chart review of children hospitalized for ARI during peak prevalence of respiratory viral infections in 2009-2011. Demographics, diagnostic testing, antimicrobial use, and clinical outcomes were abstracted from the electronic medical record. Antimicrobial use was compared with RVP testing data.
  
  
  RESULTS
  A total of 1727 patients met inclusion criteria. Of these patients, 254 (14.7%) children who were hospitalized for ARI received oseltamivir and 856 (49.6%) children received antibiotics. More children who received oseltamivir were positive for influenza by RVP (76.9% vs 18.0%; P < .0001). Children who underwent RVP testing received antibiotics more often than those who were not tested (53.7% vs 46.0%; P = .001), but children with a positive RVP test result received antibiotics less often (51.6% vs 67.0%; P = .003). A total of 5.8% of children who were positive for a viral pathogen by RVP had antibiotics discontinued. Antibiotics were started in fewer children when RVP results were positive (10.9% vs 100.0%; P < .0001).
  
  
  CONCLUSIONS
  Respiratory viral panel testing was associated with more appropriate oseltamivir use in children hospitalized with ARI. Physicians started antibiotics more often in children with a negative RVP test result and occasionally discontinued antibiotics in children diagnosed with a viral pathogen. These results suggest that RVP testing may enhance physician decision-making when prescribing antimicrobials in children hospitalized with ARI.
authors.affiliation: Division of Pediatric Infectious Diseases, Children's Mercy Hospital, Kansas City, Missouri.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: McCulloh
authors.affiliation: Department of Pathology, Rhode Island Hospital.
authors.forename: Sarah
authors.initials: S
authors.lastname: Andrea
authors.affiliation: Department of Information Services, Lifespan Healthcare.
authors.forename: Steven
authors.initials: S
authors.lastname: Reinert
authors.affiliation: Department of Pathology, Rhode Island Hospital/Brown University, Providence.
authors.forename: Kimberle
authors.initials: K
authors.lastname: Chapin
keywords: antimicrobial stewardship; respiratory viral panel; virology