Improving care for pregnant women with suspected influenza: A retrospective study before and after introduction of a rapid molecular assay

OBJECTIVES: During winter, after excluding obvious sites of infection, the most important diagnoses of isolated fever or influenza-like illness (ILI) to rule out are listeriosis and influenza, because of their severe potential outcomes and the straightforward management available for each. While awaiting laboratory results, the recommended management strategy is usually hospitalization for intravenous antibiotic therapy against potential listeria. This study sought to assess the effect of the use of a rapid test on hospitalization and antibiotic therapy rates. METHODS: The study included all pregnant women who consulted for ILI or isolated fever after clinical and laboratory investigations and had a molecular diagnostic assay for influenza during two time periods, both during influenza epidemics: before introduction of the rapid molecular assay use (period 1) and after this (period 2). RESULTS: The study included 38 women during period 1 and 124 during period 2. The influenza diagnosis was confirmed for 24 of 38 (63.2%) women during period 1 and 65 of 124 (52.4%) women during period 2 (P = 0.24). The hospitalization rate fell significantly from period 1 to period 2, both in the total population (71.0% versus 44.3%, P = 0.004) and among women with confirmed influenza (83.3% versus 38.5%, P<0.001), as did the antibiotic therapy rate in both groups (respectively, 86.8% versus 56.1%, P = 0.001 and 91.7% versus 44.7%, P<0.001). CONCLUSION: The use of a rapid molecular assay for the diagnosis of influenza improved the management of pregnant women with an isolated fever or ILI by reducing the rates of unnecessary hospitalization and antibiotic therapy.