Multiplex PCR for detection of respiratory viruses: Can the laboratory performing a respiratory viral panel (RVP) assay trigger better patient care and clinical outcomes?

摘要

Acute respiratory infection (ARI) is a leading cause of hospital-ization and acute care visits for infants and children, with the majority of patients being under 3 years of age. Most of these illnesses are due to viruses but concern about concurrent bacterial infections, results in excessive testing, overuse of antibiotics, and increased length of stay. Because different viral pathogens circulate simultaneously, viral epidemiology can vary from season to season, and clinical signs and symptoms are overlapping, a specific viral diagnosis cannot be made based on clinical presentation alone, thus resulting in overuse of antiviral medications as well. Fig. 1 depicts the virus etiologies during the peak weeks of the pandemic influenza AH1N1 (pH1N1) outbreak in the Hasbro Pediatric Hospital, where more than 50% of patients admitted for ARI with influenza-like symptoms had a virus other than pH1N1 identified. Molecular diagnostic tools now exist that allow detection of a large number of viruses simultaneously, termed respiratory virus panel (RVP) assays. In addition, RVP assays allow detection of viruses uncommonly evaluated for (such as rhinovirus and metapneumo-virus) with classical virologic methods including culture, direct fluorescent staining, and/or immunochromatographic techniques. Data from large clinical trials and review of literature using molecular RVP testing suggest that a molecular approach and provision of a specific viral diagnosis may be of benefit clinically as well as be cost-effective despite molecular's relatively high price tag compared to other test modalities. Data are beginning to accumulate that show that molecular testing for viral pathogens can lend to appropriate antiviral use, optimize infection control, limit antibiotics, reduce hospital stay, and help in identifying patients with the greatest risk for sequelae and severity of disease. In addition, assessing for many viruses provides ongoing information of viral epidemiology. In contras...