RESUMO
BACKGROUND: Rapid diagnostic methods for respiratory syncytial virus are useful tools available for the clinician. OBJECTIVES: The Thermo Electron RSV OIA (optical immunoassay kit) was prospectively compared with direct immunofluorescent assay and viral culture at Primary Children's Medical Center, Salt Lake City, Utah. STUDY DESIGN: Specimens from three hundred and thirty patients exhibiting respiratory symptoms were collected for testing by the three methods above. Several specimens were positive by both OIA and DFA with a negative culture result. These culture results were verified by RT-PCR analysis. RESULTS: Overall, 107 specimens were positive for RSV by the reference tests (culture or RT-PCR). DFA analysis identified an additional 40 patient specimens positive for other respiratory viruses. Compared to the reference tests the sensitivity, specificity, positive, and negative predictive values of the OIA for detection of RSV were 87.9%, 99.6%, 98.9% and 94.5%, respectively. CONCLUSIONS: The rapid OIA assay format proved to be cost effective, and simple to use in comparison to DFA and viral culture. Negative rapid test results should still be confirmed with a secondary test.
Assuntos
Técnica Direta de Fluorescência para Anticorpo , Imunoensaio , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sinciciais Respiratórios/isolamento & purificação , Cultura de Vírus , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Acute viral respiratory disease is the most common reason for pediatric hospitalization in the United States. Viral illnesses may be mistaken for bacterial infection, and antibiotic therapy may be prescribed. Overprescribing of antimicrobials for viral illness is a factor contributing to increasing antimicrobial resistance among bacterial pathogens encountered in pediatrics. OBJECTIVE: To determine if the availability of a rapid diagnostic test for respiratory viruses would affect antibiotic use in a children's hospital. DESIGN: Retrospective medical record review. SETTING: A 232-bed urban children's hospital. PARTICIPANTS: All hospitalized infants and children who underwent rapid testing (SimulFluor Respiratory Screen; Chemicon International Inc, Temecula, Calif) for respiratory viruses by direct fluorescent assay (DFA) during 2 successive winter seasons. MAIN OUTCOME MEASURES: Rates of antibiotic prescribing in DFA-positive and DFA-negative patients during the 2 study periods. RESULTS: During the first winter season, DFA-positive patients had fewer days using intravenous antibiotics (2.4 vs 4, P =.04), fewer days using oral antibiotics (0.25 vs 2.5, P =.04), and fewer discharge prescriptions for oral antibiotics (37% vs 52%, P =.02) when compared with DFA-negative patients. Intravenous antibiotics were initiated less often for DFA-positive patients during the second winter season than during the first (26% vs 44%, P =.008). CONCLUSIONS: Direct fluorescent assay testing was associated with a decrease in inappropriate antibiotic use. The availability of rapid viral diagnostics is an important tool for decreasing antibiotic prescribing in pediatric patients.
Assuntos
Antibacterianos/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Doenças Respiratórias/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Técnica Direta de Fluorescência para Anticorpo , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Prontuários Médicos , Doenças Respiratórias/microbiologia , Doenças Respiratórias/virologia , Estudos Retrospectivos , Estações do Ano , UtahRESUMO
The Binax NOW immunochromatographic assay for respiratory syncytial virus was prospectively compared with direct fluorescent assay and viral culture at Primary Children's Medical Center, Salt Lake City, Utah during February 2003. Three hundred ten patient specimens were collected for testing, of which 102 specimens were positive for respiratory syncytial virus by the reference tests, direct immunofluorescence assay (DFA), and culture or molecular analysis. DFA analysis identified an additional 40 patient specimens positive for other respiratory viruses. Compared to the reference tests, the sensitivity, specificity, and positive and negative predictive values of the rapid immunochromatographic assay for detection of respiratory syncytial virus were 89.2%, 100.0%, 100.0%, and 94.9%, respectively. This rapid assay format proved to be cost-effective and simple to use in comparison to DFA and viral culture. Negative rapid test results should still be confirmed with a secondary test.
Assuntos
Kit de Reagentes para Diagnóstico , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sincicial Respiratório Humano/isolamento & purificação , Adolescente , Criança , Pré-Escolar , Cromatografia , Feminino , Técnica Direta de Fluorescência para Anticorpo , Humanos , Imunoensaio , Lactente , Recém-Nascido , Masculino , Infecções por Vírus Respiratório Sincicial/virologia , Sensibilidade e Especificidade , Fatores de Tempo , Cultura de VírusRESUMO
BACKGROUND: Adenovirus (ADV) infections were difficult to diagnose in the past, and many infections were unrecognized. Direct fluorescent assay (DFA) for the rapid diagnosis of ADV infection, as part of a viral respiratory panel, became available at Primary Children's Medical Center (Salt Lake City, UT) in December 2000. OBJECTIVE: To describe children with ADV infection diagnosed by DFA and viral culture and document the impact of rapid ADV testing on patient care. METHODS: DFA testing for respiratory viruses including ADV was performed on nasal wash specimens with parallel viral culture. Chart review was performed for all ADV-positive patients identified from microbiology records between December 2000 and May 2002. RESULTS: Of 1901 patients positive for respiratory viruses, 143 (7.5%) were ADV-positive by DFA or culture. The mean age of ADV-positive children was 23 months; 90% were Assuntos
Infecções por Adenoviridae/diagnóstico
, Adenoviridae/isolamento & purificação
, Infecções por Adenoviridae/epidemiologia
, Infecções por Adenoviridae/terapia
, Adolescente
, Adulto
, Criança
, Pré-Escolar
, Feminino
, Técnica Direta de Fluorescência para Anticorpo
, Humanos
, Lactente
, Recém-Nascido
, Falência Hepática/complicações
, Masculino
, Síndrome de Linfonodos Mucocutâneos/complicações
, Assistência ao Paciente
, Infecções Respiratórias/virologia
, Estações do Ano
, Sensibilidade e Especificidade
, Fatores de Tempo