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Pediatr Pulmonol. 2011 May;46(5):428-34. doi: 10.1002/ppul.21385. Epub 2010 Dec 30.

Impact of PCR for respiratory viruses on antibiotic use: theory and practice.

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Division of Infectious Diseases, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands.



Real-time polymerase chain reaction (PCR) for respiratory viruses is more sensitive, yet more expensive, than conventionally used direct immunofluorescence (DIF). We determined the impact of real-time PCR, additional to DIF, on antibiotic prescription in ventilated children with lower respiratory tract infection (LRTI) at admission to the pediatric intensive care unit (PICU).


First, a multicenter survey study was performed. Subsequently, in a prospective study, children (≤ 5 years) with LRTI were tested at admission by DIF and PCR. Positive DIF results were reported at the end of the first working day. PICU physicians reported antibiotic treatment on the second working day. After informing them of the PCR result antibiotic treatment was reevaluated.


The multicenter survey study (94 respondents) showed that PCR decreased antibiotic use (P < 0.001). In the prospective study 38 children were included, of which 19 (50%) were DIF positive. Of the 19 DIF negative patients 12 (63%) were treated with antibiotics before revealing the PCR result; the PCR test was positive in 9 out of 12. Revealing PCR results did not alter antibiotic treatment. In 7 DIF negative patients antibiotics not given, the PCR test was positive.


In contrast to their responses to the survey study, in real-life PICU physicians did not let their antibiotic prescription be influenced by respiratory real-time PCR in children ventilated for LRTI.


anti-bacterial agents; patient care management; pediatric intensive care units; questionnaires; real-time polymerase chain reaction; viral lower respiratory tract infections

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