Does the Use of the Respiratory Pathogen Panel Impact the Management and Outcomes of Young Infants Presenting with Fever?

Background: The multiplex polymerase chain reaction Respiratory Pathogen Panel (RPP) has been utilized at Jersey Shore University Medical Center for the diagnosis of infants with fever of unknown source whose rapid RSV and/or influenza testing were negative. However, the value of RPP testing in terms of medical care and outcomes is unknown. Our objectives were to assess whether utilization of diagnostic tests varied by RPP results in young infants with fever and to determine if antibiotic administration differed with identification of viral pathogen(s).

Methods: We identify patients with fever aged 29 to 90 days on whom an RPP was performed as part of the diagnostic work-up at ED presentation and/or admission from October 2015 to April 2019. Electronic health records have been used to verify demographic, clinical and diagnostic data that were compared with respect to the positive RPP using univariate analysis. Factors that showed a difference between study groups at a level of P<0.05 were selected for inclusion in controlled regression models. Statistical data are presented as proportion (%) and odds ratio controlled for relevant co-variants (OR), including 95% Confidence interval (95%CI).

Results: Among 135 patients included, 69.6% tested positive for at least one of the 18 respiratory pathogens, mostly human rhinovirus/enterovirus. Two or more pathogens were detected in 18.4% of patients with positive RPP. Demographic and clinical characteristics of patients who tested positive and negative were comparable except for prevalence of symptoms of upper respiratory infection that were more likely recorded in infants with positive RPP results (P <0.03). LP was performed in 7.5% and 19.5% (OR 0.33, 95%CI 0.11, 0.99, P<0.05), blood culture in 70.2% and 87.8% (OR 0.33, 95%CI 0.12, 0.92, P<0.03), and urine culture in 62.8% and 82.9% (OR 0.35, 95%CI 0.14, 0.87, P<0.02) of patients with positive and negative RPP results, respectively. There was no difference in use of antibiotics (18.1% vs. 12.2%, P=0.39). The rate of hospitalization was lower in RPP positive patients compared to those with negative RPP studies (36.6% vs. 63.4%, OR 0.29, 95%CI 0.14, 0.63, P<0.01).

Conclusion: Utilization of hospital-based services reduced significantly in young infants with fever who tested positive for respiratory pathogen(s). The cost-benefit analysis will be needed to aid decisions regarding inclusion of RPP in management of young infants with fever who are at risk for serious bacterial infection.