The effect of rapid respiratory viral diagnostic testing on antibiotic use in a children's hospital

Background: Acute viral respiratory disease is the most common reason for pediatric hospitalization in the United States. Viral illnesses may be mistaken for bacterial infection, and antibiotic therapy may be prescribed. Over-prescribing of antimicrobials for viral illness is a factor contributing to increasing antimicrobial resistance among bacterial pathogens encountered in pediatrics. Objective: To determine if the availability of a rapid diagnostic test for respiratory viruses would affect antibiotic use in a children's hospital. Design: Retrospective medical record review. Setting: A 232-bed urban children's hospital Participants: All hospitalized infants and children who underwent rapid testing (SimulFluor Respiratory Screen; Chemicon International Inc, Temecula, Calif) for respiratory viruses by direct fluorescent assay (DFA) during 2 successive winter seasons. Main Outcome Measures: Rates of antibiotic prescribing in DFA-positive and DFA-negative patients during the 2 study periods. Results: During the first winter season, DFA-positive patients had fewer days using intravenous antibiotics (2.4 vs 4, P = .04), fewer days using oral antibiotics (0.25 vs 2.5, P = .04), and fewer discharge prescriptions for oral antibiotics (37% vs 52%, P = .02) when compared with DFA-negative patients. Intravenous antibiotics were initiated less often for DFA-positive patients during the second winter season than during the first (26% vs 44%, P = .008). Conclusions: Direct fluorescent assay testing was associated with a decrease in inappropriate antibiotic use. The availability of rapid viral diagnostics is an important tool for decreasing antibiotic prescribing in pediatric patients.