Impact of multiplex PCR respiratory viral panel testing on antibiotic utilisation in children with acute febrile and respiratory illnesses

BACKGROUND: The utility of a PCR-based respiratory virus panel (RVP) in limiting antibiotic overuse in paediatric febrile and respiratory illnesses in low- and middle-income countries remains unclear. METHODS: This retrospective study included inpatients who underwent RVP testing within 48 hours of admission between January 2021 and December 2022. The primary outcome was the impact of the respiratory viral panel result on total duration of antibiotics. The secondary outcome was discontinuation of antibiotics following test results and duration of antibiotics in specific subgroups. A zero-inflated negative binomial (ZINB) regression identified predictors of outcome. RESULTS: Of the 210 cases, 152 (72.3%) tested positive for ≥1 virus. 42% of patients had their antibiotics discontinued after getting a positive result. Overall, we noted a minimal effect of a positive RVP result in reducing antibiotic utilisation. However, in influenza patients, we observed a significant decrease in median antibiotic days compared with those with negative RVP (3 days (IQR 0-5.5) vs 6 days (IQR 2.25-8); p=0.011). Patients with acute febrile illness with viral aetiology received fewer days of antibiotics compared with those with negative RVP (2.5 days (IQR 0-5) vs 5 days (IQR 2-7); p=0.035). ZINB regression analysis showed that pneumonia patients (OR=1.27; p=0.03) and those with paediatric intensive care unit stay (1.2; 0.02) had higher odds of prolonged antibiotic use despite RVP positivity. CONCLUSION: In our setting, RVP reduced antibiotic use in specific subgroups like influenza-positive patients and those with acute febrile illness and could be potentially used as an antibiotic stewardship tool in these settings.