The clinical utility of respiratory viral testing in critically ill infants with viral bronchiolitis
CCCF ePoster library. Noel K. 11/12/19; 283419; EP74
Kim Noel
Kim Noel
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Abstract
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Noël, Kim C.1; Aljassim, Nada2; Maratta, Christina3; Tam, Ingrid4; Almadani, Ahmed5; Papenburg, Jesse1,6; Quach, Caroline7; Thampi, Nisha8; Dendukuri, Nandini1; O'Donnell, Shauna9; Fontela, Patricia S.1,5
1Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; 2King Fahad Medical City, Riyadh, Saudi Arabia; 3Pediatric Critical Care, Hospital for Sick Children, Toronto, Canada; 4Faculty of Medicine, University of Limerick, Limerick, Ireland; 5Department of Pediatrics, McGill University, Montreal, Canada; 6Division of Pediatric Infectious Diseases, Department of Pediatrics, McGill University, Montreal, Canada; 7Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada; 8Department of Pediatrics, University of Ottawa, Ottawa, Canada; 9Research Institute of the McGill University Health Centre, Montreal, Canada


INTRODUCTION: Bronchiolitis is a leading cause of infant hospitalization.1 It is most commonly caused by respiratory syncytial virus. However, antibiotics are frequently used in this patient population due to the risk of concomitant bacterial infection and superinfection.2 This contributes to the major public health issue of antibiotic overuse and bacterial resistance in hospitals. While bronchiolitis is a clinical diagnosis, respiratory viral (RV) tests are frequently used as part of patient management. However, their clinical utility in decreasing unnecessary antibiotic use remains unclear.3
 
OBJECTIVES: To determine the impact of RV test results (positive versus negative) on the use of antibiotics in critically ill infants with bronchiolitis.
 
METHODS: A retrospective cohort study of children <2 years of age with a clinical diagnosis of bronchiolitis admitted to the pediatric intensive care units at the Montreal Children's Hospital (MCH), the Centre Hospitalier Universitaire de Sainte Justine (CHUSJ), or the Children's Hospital of Eastern Ontario (CHEO) during 2 winter seasons (2016-2017 and 2017-2018). We analysed study data using descriptive statistics, Chi-squared test, Student's t-test, and Wilcoxon's rank-sum test.
 
RESULTS: A total of 372 patients were included in the study. Mean age was 4.8±5.3 months. RV testing was performed in 354 (95%) patients, and of these, 233 (66%) received antibiotics. Overall, there was no difference in the odds of receiving antibiotics between patients with a positive versus negative RV test results (odds ratio 1.1; 95% confidence interval 0.7, 2.0), nor in the median number of days of antibiotic treatment (3 days, interquartile range [IQR] 2 – 7 vs. 4 days, IQR 2 – 9, p = 0.38). The proportion of patients in whom antibiotics were stopped did not differ between patients with a positive versus negative test result within 48 hours (23% vs. 27%, p = 0.74) or 72 hours (50% vs. 45%, p = 0.74) of admission. Stratification by hospital and type of infection (viral only or clinical diagnosis of bacterial infection) also showed no significant difference in antibiotic use for any outcome. Lastly, of patients with a viral infection only, 25% still received a full course (≥7 days) of antibiotics.
 
CONCLUSIONS: RV testing does not appear to impact the use of antibiotics in critically ill infants with bronchiolitis. There is thus insufficient evidence to support the routine use of RV testing in this patient population.


Image
1. Shi T, McAllister DA, O'Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. The Lancet;390:946-58.
2. Papenburg J, Fontela PS, Freitas RR, Burstein B. Inappropriate Antibiotic Prescribing for Acute Bronchiolitis in US Emergency Departments, 2007–2015. Journal of the Pediatric Infectious Diseases Society;piy131.
3. Noël KC, Fontela P, Winters N, et al. The Clinical Utility of Respiratory Viral Testing in Hospitalized Children: A Meta-analysis. Hospital pediatrics;9:483-494.
ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Noël, Kim C.1; Aljassim, Nada2; Maratta, Christina3; Tam, Ingrid4; Almadani, Ahmed5; Papenburg, Jesse1,6; Quach, Caroline7; Thampi, Nisha8; Dendukuri, Nandini1; O'Donnell, Shauna9; Fontela, Patricia S.1,5
1Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; 2King Fahad Medical City, Riyadh, Saudi Arabia; 3Pediatric Critical Care, Hospital for Sick Children, Toronto, Canada; 4Faculty of Medicine, University of Limerick, Limerick, Ireland; 5Department of Pediatrics, McGill University, Montreal, Canada; 6Division of Pediatric Infectious Diseases, Department of Pediatrics, McGill University, Montreal, Canada; 7Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada; 8Department of Pediatrics, University of Ottawa, Ottawa, Canada; 9Research Institute of the McGill University Health Centre, Montreal, Canada


INTRODUCTION: Bronchiolitis is a leading cause of infant hospitalization.1 It is most commonly caused by respiratory syncytial virus. However, antibiotics are frequently used in this patient population due to the risk of concomitant bacterial infection and superinfection.2 This contributes to the major public health issue of antibiotic overuse and bacterial resistance in hospitals. While bronchiolitis is a clinical diagnosis, respiratory viral (RV) tests are frequently used as part of patient management. However, their clinical utility in decreasing unnecessary antibiotic use remains unclear.3
 
OBJECTIVES: To determine the impact of RV test results (positive versus negative) on the use of antibiotics in critically ill infants with bronchiolitis.
 
METHODS: A retrospective cohort study of children <2 years of age with a clinical diagnosis of bronchiolitis admitted to the pediatric intensive care units at the Montreal Children's Hospital (MCH), the Centre Hospitalier Universitaire de Sainte Justine (CHUSJ), or the Children's Hospital of Eastern Ontario (CHEO) during 2 winter seasons (2016-2017 and 2017-2018). We analysed study data using descriptive statistics, Chi-squared test, Student's t-test, and Wilcoxon's rank-sum test.
 
RESULTS: A total of 372 patients were included in the study. Mean age was 4.8±5.3 months. RV testing was performed in 354 (95%) patients, and of these, 233 (66%) received antibiotics. Overall, there was no difference in the odds of receiving antibiotics between patients with a positive versus negative RV test results (odds ratio 1.1; 95% confidence interval 0.7, 2.0), nor in the median number of days of antibiotic treatment (3 days, interquartile range [IQR] 2 – 7 vs. 4 days, IQR 2 – 9, p = 0.38). The proportion of patients in whom antibiotics were stopped did not differ between patients with a positive versus negative test result within 48 hours (23% vs. 27%, p = 0.74) or 72 hours (50% vs. 45%, p = 0.74) of admission. Stratification by hospital and type of infection (viral only or clinical diagnosis of bacterial infection) also showed no significant difference in antibiotic use for any outcome. Lastly, of patients with a viral infection only, 25% still received a full course (≥7 days) of antibiotics.
 
CONCLUSIONS: RV testing does not appear to impact the use of antibiotics in critically ill infants with bronchiolitis. There is thus insufficient evidence to support the routine use of RV testing in this patient population.


Image
1. Shi T, McAllister DA, O'Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. The Lancet;390:946-58.
2. Papenburg J, Fontela PS, Freitas RR, Burstein B. Inappropriate Antibiotic Prescribing for Acute Bronchiolitis in US Emergency Departments, 2007–2015. Journal of the Pediatric Infectious Diseases Society;piy131.
3. Noël KC, Fontela P, Winters N, et al. The Clinical Utility of Respiratory Viral Testing in Hospitalized Children: A Meta-analysis. Hospital pediatrics;9:483-494.
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