Detection of Respiratory Viruses is Associated with Decreased Antibiotic Use in Children Hospitalized with Pneumonia

Background:   Although respiratory viruses are frequently identified in children with community-acquired pneumonia (CAP), the clinical utility of specific viral diagnostics has not been fully explored in this population. Our objectives were to 1) determine the frequency of respiratory virus detection and 2) evaluate the impact of viral detection on antibiotic usage in children hospitalized with CAP. 

Methods: Prospective, observational study of patients 2 months to 18 years hospitalized with CAP at NCH from February 1, 2011, to January 31, 2012. Nasopharyngeal (NP) swabs were collected within 24 hours of hospitalization and two multiplex polymerase chain reaction (PCR) assays for respiratory viruses [xTAG respiratory viral panel IVD (RVP) & xTAG RVP FAST RUO, Luminex, Austin, TX] were performed. In this initial phase of the study, the RVP results were not available for clinical decision-making but viral culture, direct fluorescent antibody testing, and select lab-developed PCRs for respiratory viruses could be ordered at the discretion of the attending physician based on current routine practice. Demographic, clinical, laboratory, and outcome data were collected via chart review.

Results:   Of 143 patients with an NP sample analyzed by RVP, a total of 122 respiratory viruses were detected in 97 (67%) patients, with multiple viruses in 20 (14%) children.  There were 65 (53%) viruses detected during standard of care testing and an additional 57 (47%) viruses detected by RVP. The viruses most frequently detected were rhinovirus (n=55; 38%), human metapneumovirus (n=18; 13%), parainfluenza (n=16; 11%), and respiratory syncytial virus (n=13; 9%). In children without confirmed bacterial infection, clinicians were more likely to withhold or discontinue antibiotics if a positive viral result was known during routine care compared with children with viruses only discovered during research testing (OR 10.0; 95% CI: 2.1-47; p=0.0007). 

Conclusion:   When tested in a comprehensive and standardized fashion using RVP, respiratory viruses were detected in the majority of children hospitalized with CAP.  Physicians were more likely to withhold or discontinue antibiotics in patients with a known positive viral test result. Routine implementation of viral testing may lead to decreased antibiotic usage in this population.