Clinical impact of using a rapid multiplex pcr for respiratory pathogen detection in the emergency department

ECHAVARRIA MARCELA; QUERCI MARCIA; VIDELA CRISTINA; EKSTROM JORGE; MARCONE DÉBORA NATALIA; RICARTE CARMEN; SEOANE A; YPAS M; O'FARREL C; VIDAURRETA SANTIAGO; CARBALLAL GUADALUPE

Congreso; 33rd Annual Meeting Pan American Society for Clinical Virology; 2017

ASM

Background:Acute Respiratory Infection (ARI) is one of themost frequent consultations in the Emergency Department (ED). Most of them areof viral origin. The unnecessary use of antibiotics remains a significantconcern worldwide.OBJECTIVETo evaluate changes in medical management inrelation to antimicrobial prescriptions and complimentary studies in patientswith ARI who consult at the Emergency Department when using a fast andcomprehensive method (FilmArray® Respiratory Panel) versus Immunofluorescence.Methods:A prospective study withimmunocompetent children and adults who consulted at the ED for Lower ARI was conducted from April to November 2016. A nasopharyngeal swab was obtainedwith a flexible flocked swab (Puritan, USA)and collected in viral transport media. Randomization was performed in thelaboratory to determine which samples would be tested by FilmArray versus IF. FilmArray detects 20 pathogens while IF detects 7 viruses.Results:A total of 333 patients (142 children and 191adults) with Lower ARI were enrolled.240 patients were tested by FilmArrayand 93 patients by IF. In CHILDREN, a medical change occurredin 23/57 (54 %) patients diagnosed by FilmArray and in 6/37 (16%) childrendiagnosed by IF (p<0.001). These changes were associated to a decrease inantibiotics prescription Odd Ratio (OR) = 10, 27 [95% CI, 1.32 to 79.31] andcomplimentary studies required OR= 5.54 (CI 1.22 to 25.0) when using Film Array. No difference was observed betweenboth methods for oseltamivir prescription. In ADULTS, a medical change occurredin 44/135 (33%) patients diagnosed by FIlmArray and in 4/56(7%) patientsdiagnosed by IF (p<0.001). These changes were associated to a decrease inantibiotics prescription OR= 10,31 (1,34-78,97) when using FilmArray. Reductionin oseltamivir remained significant in patients older than 65 years old (OR=11,39 (2,32-55,94) when tested by FilmArray. Increase in oseltamivir occurred in7 FilmArray Flupositive patients who otherwise would not have received the drug. In children, a respiratory pathogenwas detected in 92% by FilmArray (99% were viruses and 1% Mycoplasma) and 51% by IF. In adults, a virus was detected in 71%by FilmArray and 14% by IF. Conclusions:A significant change in medical management occurredwhen using the FilmArray Respiratory Panel. These changes were principallyrelated to a decrease in antibiotics indication, a decrease in the request ofcomplementary studies (x-rays in children) and a decrease in oseltamivirprescription (in adults more than 65 years old).