Syndromic Diagnostics of Respiratory Infections in Children As One of Antibiotic Management Tools in a Hospital

Abstract

An observational, ambispective, non-interventional study was conducted to compare the effectiveness of introducing syndromic diagnostic according to the RP-2021 protocol on the basis of the pediatric departments of the Morozov Children's City Clinical Hospital. The study was carried out in two phases. The prospective phase (February–June 2022) was conducted using multiplex PCR tests (mPCR) – BioFire FilmArray respiratory panel – and routine diagnostic tests according to accepted standards for patient examination. The second phase of the study was a retrospective analysis of the comparison group’s (historical control group) primary medical records for standard test results from the same time frame, February to June 2021. Data on 40 patients on the historical control group were taken from the CIS EMIAS system. The mPCR results of the prospective group were available to the doctor several hours later, at the very beginning of the diagnostic algorithm. The length of the hospital stay in the prospective period following the introduction of mPCR testing was reduced by one day compared to the period before the introduction of this technology. The study showed that express methods of syndromic diagnostic testing allow to quickly establish the etiology of a respiratory infection for preterm infants, as well as children with bronchopulmonary dysplasia, bronchiolitis, comorbid patients, patients in the ICU with suspected influenza, whooping cough, and atypical pathogens, which in turn optimizes antibiotics prescription and hospitalization time. This study highlights the importance of rapid diagnosis of respiratory pathogens in pediatric patients under the age of five in order to optimize patient management when admitting them to the emergency department with a suspected acute respiratory infection. In the prospective observation group after the introduction of mPCR testing, patients were significantly less likely to receive antibiotics — 47.5% (n=19) compared to the historical control group of 72.5% (n=29). The study presents the advantages of the syndromic approach to the diagnosis of respiratory infections in children as one of the most effective tools for increasing the rationality of antibiotic use in a children's hospital.