Clinical Impact of Two Different Multiplex Respiratory Panel Assays on Management of Hospitalized Children Aged ≤24 months

BACKGROUND: Highly multiplexed molecular assays are popular in clinical laboratories due their high sensitivity, specificity and relatively rapid turn-around time (TAT) for results. Luminex™ respiratory viral panel (RVP) detects 12 respiratory viruses, while BioFire™ respiratory panel (RP) detects 20 respiratory pathogens (17 viruses, 3 bacteria). The aim of the current study was to compare the impact of RVP and RP assay on management of hospitalized children aged ≤24 months. METHODS: Retrospective data were collected to compare the clinical impact from two multiplex molecular assays (RVP, December 2008–May 2012; RP August 2012–June 2015) on management and outcomes of hospitalized patients. Patients aged ≤24 months and positive for at least one respiratory virus were included. Patients who were (1) receiving immune suppressive therapy, (2) neonates requiring intensive care, or (3) hospitalized for >7 days were excluded. RESULTS: A total of 810 patients in RVP and 2,095 patients in RP group were included. The median TAT for RVP and RP assay were 29 hours (IQR 26–58 hours) and 4 hours (IQR 2–8 hours), respectively (P < 0.001). Significantly higher number of children in RVP group (44%, 357/810) received empiric antibiotic therapy compared with RP group (28%, 595/2095) (P < 0.001). Following PCR test reporting, the rate of antibiotic discontinuation was higher in the RP group (23%, 135/595) vs. RVP group (16%, 56/357) (P < 0.001). Antibiotics were discontinued more often in older children aged 6–24 months (23%, 113/492) compared with children aged < 60 days (11%, 34/297) (P < 0.001). Following positive influenza test results, more children received timely oseltamivir in the RP group (85%, 48/56) compared with the RVP group (17%, 7/41) (P < 0.001). The median length of hospitalization (LOH) was shorter in the RP group (48 hours, IQR 32–76 hours) than in the RVP group (54 hours, IQR 39–89 hours) (P < 0.001). CONCLUSION: Rapid availability of test results from RP assay was associated with reduced antibiotic use, timely antiviral therapy and decreased LOH. The implementation of a more comprehensive respiratory multiplex molecular assay with rapid reporting of test results has the potential to improve management of hospitalized children, decrease unnecessary antibiotic therapy and reduce overall costs. DISCLOSURES: R. Selvarangan, BioFire Diagnostics: Board Member and Investigator, Consulting fee and Research grant; Luminex Diagnostics: Investigator, Research grant