Impact of PCR for respiratory viruses on antibiotic use: Theory and practice
Alma C. van de Pol MD, PhD
Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorTom F.W. Wolfs MD, PhD
Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorCarline E.A. Tacke MD
Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorCuno S.P. Uiterwaal MD, PhD
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorJohannes Forster MD, MME
Department of Pediatrics, St. Josefskrankenhaus and University Hospital Freiburg, Freiburg, Germany
Search for more papers by this authorAnton M. van Loon PhD
Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorJan L.L. Kimpen MD, PhD
Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorJohn W.A. Rossen PhD
Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands
Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands
Search for more papers by this authorCorresponding Author
Nicolaas J.G. Jansen MD, PhD
Department of Pediatrics, Division of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Pediatrics, Room KG.01.319.0, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands.Search for more papers by this authorAlma C. van de Pol MD, PhD
Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorTom F.W. Wolfs MD, PhD
Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorCarline E.A. Tacke MD
Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorCuno S.P. Uiterwaal MD, PhD
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorJohannes Forster MD, MME
Department of Pediatrics, St. Josefskrankenhaus and University Hospital Freiburg, Freiburg, Germany
Search for more papers by this authorAnton M. van Loon PhD
Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorJan L.L. Kimpen MD, PhD
Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
Search for more papers by this authorJohn W.A. Rossen PhD
Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands
Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands
Search for more papers by this authorCorresponding Author
Nicolaas J.G. Jansen MD, PhD
Department of Pediatrics, Division of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Pediatrics, Room KG.01.319.0, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands.Search for more papers by this authorAbstract
Rationale for the study
Real-time polymerase chain reaction (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 multicenter survey study was performed. Subsequently, in a prospective 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 multicenter survey study (94 respondents) showed that PCR decreased antibiotic use (P < 0.001). In the prospective 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 antibiotics not given, 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. Pediatr. Pulmonol. 2011; 46:428–434. © 2010 Wiley-Liss, Inc.
Supporting Information
Additional Supporting Information may be found in the online version of this article.
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