Highly multiplexed molecular assays are popular in clinical laboratories due their high sensitivity, specificity and relatively rapid turn-around time (TAT) for results. Luminex™ respiratory viral panel (RVP) detects 12 respiratory viruses, while BioFire™ respiratory panel (RP) detects 20 respiratory pathogens (17 viruses, 3 bacteria). The aim of the current study was to compare the impact of RVP and RP assay on management of hospitalized children aged ≤24 months.
Retrospective data was collected to compare the clinical impact from two multiplex molecular assays (RVP, Dec 2008-May 2012; RP Aug 2012-June 2015) on management and outcomes of hospitalized patients. Patients aged ≤ 24 months and positive for at least one respiratory virus were included. Patients who were i) receiving immune suppressive therapy, ii) neonates requiring intensive care, iii) or hospitalized for >7 days were excluded.
Results: A total of 810 patients in RVP and 2095 patients in RP group were included. The median TAT for RVP and RP assay were 29 hours (IQR 26-58 hrs) and 4 hours (IQR 2-8 hrs), respectively (p < 0.001). Significantly higher number of children in RVP group (44%, 357/810) received empiric antibiotic therapy compared to RP group (28%, 595/2095) (p < 0.001). Following PCR test reporting, rate of antibiotic discontinuation was higher in the RP group (23%, 135/595) versus RVP group (16%, 56/357) (p < 0.001). Antibiotics were discontinued more often in older children aged 6-24 month (23%, 113/492) compared to children age <60 days (11%, 34/297) (p < 0.001). Following positive influenza test results, more children received timely oseltamivir in RP group (85%, 48/56) compared to RVP group (17%, 7/41) (p < 0.001). The median length of hospitalization (LOH) was shorter in the RP group (48 hours, IQR 32-76 hrs) versus RVP group (54 hours, IQR 39-89 hrs) (p < 0.001).
Conclusion: Rapid availability of test results from RP assay was associated with reduced antibiotic use, timely antiviral therapy and decreased LOH. The implementation of a more comprehensive respiratory multiplex molecular assay with rapid reporting of test results has the potential to improve management of hospitalized children, decrease unnecessary antibiotic therapy and reduce overall costs.
J. Goldman, None
M. A. Jackson, None
R. Selvarangan, BioFire Diagnostics: Board Member and Investigator , Consulting fee and Research grant
Luminex Diagnostics: Investigator , Research grant