Association Between Point-of-Care Viral Testing for Influenza and Adenovirus and Antibiotic Management in a Pediatric Emergency Department in Italy

TL;DR

Using rapid viral tests in a pediatric emergency department reduced unnecessary antibiotic use without increasing return visits.

Contribution

Demonstrates real-world impact of point-of-care viral testing on antibiotic stewardship in pediatric emergency care.

Findings

RDT positivity for influenza/adenovirus was linked to fewer new antibiotic prescriptions in untreated children.

RDT-positive results led to higher discontinuation of antibiotics in children already on treatment.

No increase in 72-hour return visits was observed after RDT-guided antibiotic decisions.

Abstract

What are the main findings?
Rapid Diagnostic Test (RDT) positivity for influenza or adenovirus was associated with lower antibiotic prescription and higher discontinuation of pre-existing antibiotic therapy in children with febrile respiratory illness.Antibiotic prescription or discontinuation decisions made after RDT results were not associated with higher 72-h return rates.

Rapid Diagnostic Test (RDT) positivity for influenza or adenovirus was associated with lower antibiotic prescription and higher discontinuation of pre-existing antibiotic therapy in children with febrile respiratory illness.

Antibiotic prescription or discontinuation decisions made after RDT results were not associated with higher 72-h return rates.

What are the implications of the main findings?
Bedside viral RDTs may support diagnostic assessment and antibiotic decision-making in clinically stable children.Wider adoption of RDTs may contribute to optimizing antibiotic use in acute pediatric settings but their effectiveness on AMR requires further dedicated studies.

Bedside viral RDTs may support diagnostic assessment and antibiotic decision-making in clinically stable children.

Wider adoption of RDTs may contribute to optimizing antibiotic use in acute pediatric settings but their effectiveness on AMR requires further dedicated studies.

Background: Respiratory tract infections (RTIs) represent one of the most prevalent reasons for visits to Pediatric Emergency Departments (PEDs). Because viral and bacterial presentations frequently overlap, a substantial proportion of antibiotic prescriptions in pediatric acute care are potentially unnecessary, contributing to antimicrobial resistance. Rapid Diagnostic Tests (RDTs) for respiratory viruses have been suggested as tools to enhance diagnostic precision and support antimicrobial stewardship. However, evidence regarding their real-world impact in pediatric emergency settings is limited. Objectives: This study aimed to assess the association between point-of-care RDT results and antibiotic management in a tertiary PED, focusing on both the discontinuation of antibiotics in children already receiving treatment and the avoidance of new antibiotic prescriptions in untreated children. The secondary objective was to evaluate the short-term safety through 72-h return visits. Methods: A retrospective cohort study was conducted at a tertiary PED during two epidemic seasons (December–February 2023–2024 and 2024–2025). Children aged <18 years who underwent RDTs for febrile respiratory illnesses were included. Patients were stratified based on whether they were already receiving antibiotic therapy at presentation. The primary outcomes were antibiotic discontinuation among treated patients and initiation among untreated patients. Unplanned return visits to the PED within 72-h post-discharge were used as a pragmatic short-term safety outcome to capture early clinical deterioration. RDTs (SD Biosensor Standard F Antigen) were performed at the bedside with a turnaround time of 10–15 min. Results: A total of 1238 children were included, of whom 330 (26.6%) tested positive for influenza and/or adenovirus. Among the 234 children already receiving antibiotics, discontinuation was significantly more frequent in the RDT-positive group (p < 0.001; OR 0.044). Among the 1004 untreated children, antibiotic prescription was significantly lower in the positive group than in the negative group (p < 0.001; OR 0.097). Return visits within 72-h did not differ between the groups in either cohort. No invalid tests occurred. Conclusions: Influenza/adenovirus RDT positivity was associated with lower antibiotic initiation among untreated children and higher discontinuation among those already receiving antibiotics, with no differences in 72-h return visits. These findings suggest a potential role for bedside viral testing as a decision-support tool for antibiotic management in the PED.

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