Usefulness of the Combination of FilmArray and procalcitonin in respiratory infections in the Pediatric Intensive Care Unit

Abstract

Abstract Introduction . Acute respiratory infections represent one of the main causes of preventable infant mortality and morbidity in children, and although a significate proportion of cases are of viral etiology, antibiotic treatment is the overly-excessive norm. Studies suggest that the combined use of serum procalcitonin (PCT) and polymerase chain reaction (PCR) multiplex (FilmArray) may be used to guide antibiotic therapy. Methods . A prospective cohort study was conducted of patients between 1 month and 17 years of age with acute respiratory infection hospitalized in the PICU with a negative viral panel report and both respiratory FilmArray and procalcitonin performed in the first 72 hours of hospitalization. A diagnostic algorithm was then applied to these patients, tailored to the result of both tests. Results . Of the total 326 patients recluted, 110 met the inclusion criteria; 23 patients were excluded for infections other than respiratory origin. Of the 87 remaining patients, all had a respiratory FilmArray performed prior to the PCT sample, demonstrating a diagnostic yield of over 80%. Procalcitonin was requested in slightly more than half of the patients and was positive in a third of these cases. When combined in the diagnostic algorithm, FilmAray and PCT lead to changes in treatment plan in 30% of patients in terms of antibiotic management prescribed on admission, with the most frequent treatment plan change being suspending the antibiotic altogether (from 41.4% to 10.3%, for a total of 89.7% of patients without antibiotic therapy following the algorithm. None of the patients died and only 1/87 patients required re-initiating antibiotics after having suspended treatment. The interaction between the identification of a viral pathogen in the FilmArray and a negative PCT result yielded statistically significant results (p=0.004) and affected the change in treatment management mainly in antibiotic discontinuation. Conclusions . The combined use of FilmArray and serum PCT as tools in the diagnostic algorithm is a safe way to guide tailored antibiotic therapy in pediatric patients with ARI in critical state.