Category: Pediatric Viral Studies (natural history and therapeutic)

Poster Session: Pediatric Viral Studies (natural history and therapeutic)

1412 - The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

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Presenting Author(s)

CARLO FOPIANO PALACIOS

Fellow
Yale New Haven Hospital
New Haven, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

EL

Eric Lemmon

Instructor
University of Maryland School of Medicine
Baltimore, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JC

James Campbell

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU.

Methods: We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed.

Results: Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value < 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay.

Conclusion: Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU.