Impact of Nested Multiplex Polymerase Chain Reaction Assay in the management of pediatric patients with acute respiratory tract infections: a single center experience

Abstract

Purpose: Acute lower respiratory infection (ALRI) re-mains a global public health problem among children. Distinguishing the etiology of ALRI is challenging and rapid pathogen identification is critical for optimizing the diagnosis and treatment of infectious diseases. Multiplex polymerase chain reaction (PCR) is sensitive, simple, and rapid. Our objective was to evaluate the diagnostic yield and prognostic significance of the Fil-mArray test for identification of pathogens in pediatric patients with ALRI at a tertiary care center. Methods: A prospective observational cross-sectional study involved 230 pediatric patients presented with acute lower respiratory tract (LRT) symptoms, for whom conventional bacterial culture and FilmArray testing was ordered to aid in the proper diagnosis of the implicated respiratory pathogens. Results: FilmArray Respiratory panel (FARP) was positive in 201 patients (87.4%). The most common detected pathogens were Respiratory syncytial virus (RSV), Human Rhino-virus/Enterovirus, Parainfluenza, Influenza A, and Klebsiella pneumoniae; 45 (19.6%), 38 (16.5%), 11 (4.8%), 8 (3.5%) and 6 (2.6%) respectively. FilmArray enabled a change in anti-microbial therapy in 168 (73%) of the patients. Conclusions: FilmArray enables to improve etiological diagnosis of ALRI and optimize the antimicrobial use of drugs in critical care pediatric patients. Clinical correlation is essential to interpret multiple pathogens and resistance genes.