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Impact of viral multiplex real-time PCR on management of respiratory tract infection: a retrospective cohort study

机译：病毒多重实时PCR对呼吸道感染管理的影响：一项回顾性队列研究

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BackgroundSignificance and clinical utility of multiple virus detection by multiplex real-time polymerase chain reaction (rtPCR) in respiratory tract infection remain unclear. MethodsThis retrospective cohort study analyzed how virus detection affected clinical management. During a 27-month period, clinical and laboratory information was collected from all children and adults in two Swiss tertiary centres whose respiratory samples were tested for respiratory viruses with a 16-plex rtPCR test. ResultsPathogens were identified in 140 of 254 patients (55%); of those patients, there was ≥1 virus in 91 (65%), ≥ 1 bacterium in 53 (38%), and ≥1 virus and bacterium in 11 (8%). Of 80 patients with viral infection, 59 (74%) received antibiotics. Virus detection was associated with discontinuation of antibiotics in 2 of 20 adults (10%) and 6 of 14 children (43%). Overall 12 adults (34%) and 18 children (67%) were managed correctly without antibiotics after virus detection ( p =?0.01). When taking biomarkers, radiologic presentations, and antibiotic pre-treatment into account, the impact of rtPCR and appropriateness of therapy for clinically viral infections increased to 100% in children and 62% in adults. ConclusionsA substantial reduction of unnecessary antibiotic prescriptions seems possible. Appropriate application of rtPCR results in respiratory tract infections should be encouraged.
机译：背景技术目前尚不清楚通过多重实时聚合酶链反应（rtPCR）检测多种病毒在呼吸道感染中的意义和临床实用性。方法这项回顾性队列研究分析了病毒检测如何影响临床管理。在27个月的时间里，从瑞士的两个三级中心收集了所有儿童和成人的临床和实验室信息，并通过16多重rtPCR测试对呼吸道样本进行了呼吸道病毒测试。结果在254例患者中有140例被确定为病原体（55％）;在这些患者中，有91例≥1病毒（65％），53例中≥1细菌（38％）和11例中有≥1病毒和细菌（8％）。在80位病毒感染患者中，有59位（74％）接受了抗生素治疗。在20名成人中的2名（10％）和14名儿童中的6名（43％）中，病毒检测与抗生素停用相关。检出病毒后，总共有12名成人（34％）和18名儿童（67％）接受了正确的抗生素治疗（p =？0.01）。当考虑到生物标志物，放射学表现和抗生素预处理时，rtPCR的影响和临床病毒感染治疗的适当性在儿童中增加到100％，在成人中增加到62％。结论大量减少不必要的抗生素处方似乎是可能的。应鼓励在呼吸道感染中适当应用rtPCR结果。

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