Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial.
Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2022.16162
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发表时间：
2022-06-01
影响因子：
13.8
通讯作者：
Tapiainen, Terhi
中科院分区：
文献类型：
--
作者：
Mattila, Suvi;Paalanne, Niko;Honkila, Minna;Pokka, Tytti;Tapiainen, Terhi
即时检测呼吸道病原体能否减少急性患儿抗生素的使用？在这项1243名儿童的随机临床试验中，呼吸道病原体的多重聚合酶链反应即时检测并没有减少急诊科抗生素的总体处方（干预组为27.3%，对照组为28.5%）。这些发现表明，检测呼吸道病原体并不能减少急性患儿抗生素的使用。本随机临床试验评估呼吸道病原体多重聚合酶链反应即时检测对急性患儿抗生素使用的影响。关于多重聚合酶链反应（PCR）即时检测急性患儿呼吸道病原体的临床影响的数据有限。目的：评价多重聚合酶链反应（PCR）即时检测呼吸道病原菌对急性患儿抗生素使用的影响。这项非盲随机临床试验于2019年5月6日至2020年3月12日进行。对参与者进行随访，直到住院或从急诊科（ED）出院。这项研究是在芬兰奥卢大学医院的儿科急诊科进行的。符合条件的研究参与者是0至17岁的儿童，有发烧和/或任何呼吸道体征或症状。有基础疾病的儿童也包括在内。统计分析时间为2020年8月11日至2021年9月14日。参与者以2:1的比例随机分配，要么在到达急诊科时接受多重PCR护理点检测（18种呼吸道病毒和3种细菌，结果在70分钟内准备好），要么接受常规护理。主要结局是接受抗生素治疗的儿童比例。次要结果是诊断测试和放射成像程序的执行次数和费用。共有1417名儿童接受了资格评估。排除后，1243名儿童（692名男孩[56%]）被随机分配到干预组（829名儿童）或对照组（414名儿童）。干预组参与者的平均（SD）年龄为3.0（3.6）岁（中位数[IQR]， 1.7[0.4-4.1]岁），对照组参与者的平均（SD）年龄为3.0（3.5）岁（中位数[IQR]， 1.9[0.4-4.1]岁）。呼吸道病原体多重PCR即时检测并未减少急诊科抗生素的总体处方（干预组226名儿童[27.3%]vs对照组118名儿童[28.5%]；风险比为0.96；95% CI为0.79-1.16）。在护理点多重PCR检测中，12名儿童（1.4%）和对照组2名儿童（0.5%）开始靶向抗生素治疗（风险比3.0;95% CI, 0.76-11.9）。两组之间诊断测试的次数没有差别，费用也没有差别。在这项随机临床试验中，即时检测呼吸道病原体并没有减少儿科急诊科抗生素的使用。呼吸道病原体检测似乎对急性患儿的临床决策影响有限。ClinicalTrials.gov标识符：NCT03932942
Does point-of-care testing for respiratory pathogens reduce antibiotic use in acutely ill children? In this randomized clinical trial of 1243 children, multiplex polymerase chain reaction point-of-care testing for respiratory pathogens did not reduce the overall prescribing of antibiotics in the emergency department (27.3% in the intervention group vs 28.5% in the control group). These findings suggest that testing for respiratory pathogens does not reduce antibiotic use in acutely ill children. This randomized clinical trial evaluates the effect of multiplex polymerase chain reaction point-of-care testing for respiratory pathogens on the antibiotic use in acutely ill children. Limited data are available on the clinical impact of multiplex polymerase chain reaction (PCR) point-of-care testing for respiratory pathogens in acutely ill children. To evaluate the effect of multiplex PCR point-of-care testing for respiratory pathogens on antibiotic use in acutely ill children. This unblinded, randomized clinical trial was conducted from May 6, 2019, through March 12, 2020. The participants were followed up until hospitalization or discharge from the emergency department (ED) for primary outcome. The study was conducted at the pediatric ED of Oulu University Hospital, Finland. Eligible study participants were children aged 0 to 17 years with fever and/or any respiratory signs or symptoms. Children with underlying medical conditions were included. The statistical analyses were performed between August 11, 2020, and September 14, 2021. The participants were randomly assigned in a 2:1 ratio either to undergo multiplex PCR point-of-care testing (18 respiratory viruses and 3 bacteria with results ready within 70 minutes) upon arrival at the ED or to receive routine care. The primary outcome was the proportion of children receiving antibiotic therapy. The secondary outcomes were the numbers of diagnostic tests and radiographic imaging procedures performed and costs. A total of 1417 children were assessed for eligibility. After exclusions, 1243 children (692 boys [56%]) were randomly allocated to either the intervention (829 children) or control (414 children) group. The mean (SD) age of the participants was 3.0 (3.6) years in the intervention group (median [IQR], 1.7 [0.4-4.1] years) and 3.0 (3.5) years (median [IQR], 1.9 [0.4-4.1] years) in the control group. Multiplex PCR point-of-care testing for respiratory pathogens did not reduce the overall prescribing of antibiotics in the emergency department (226 children [27.3%] in the intervention group vs 118 children [28.5%] in the control group; risk ratio, 0.96; 95% CI, 0.79-1.16). Targeted antibiotic therapy was started in 12 children (1.4%) tested with point-of-care multiplex PCR and 2 children (0.5%) in the control group (risk ratio, 3.0; 95% CI, 0.76-11.9). The numbers of diagnostic tests did not differ between the groups, nor did the costs. In this randomized clinical trial, point-of-care testing for respiratory pathogens did not reduce the use of antibiotics at the pediatric ED. Testing for respiratory pathogens appears to have a limited impact on clinical decision-making for acutely ill children. ClinicalTrials.gov Identifier: NCT03932942
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影响因子：
6.1
作者：
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通讯作者：
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