Bacterial versus Viral Score Test: Evaluating potential for antibiotic stewardship in pediatrics

Abstract Corresponding author contact: Denver T. Niles, M.D., 832-824-1873, [email protected], 6621 Fannin St, Mc Wb 1100, Houston, TX 77030 Alternate corresponding author contact: Sridevi Devaraj, Ph.D., 832-826-1717, [email protected], 6621 Fannin Street, West Tower B110.06, Houston, TX 77030 No conflicts of interest. Methods We retrospectively collected data from the electronic medical records of pediatric patients who received a BVT. For each patient, we extracted the following information: demographics, clinical presentation, microbiology test results, ancillary inflammatory markers (procalcitonin, C-reactive protein, and leukocyte counts), and the course of antibiotics received. An infectious disease specialist, in collaboration with a clinical chemist, adjudicated the infectious etiology (viral or bacterial) for each patient using clinical parameters, microbiology results, and radiological findings. Finally, we analyzed antibiotic use patterns among patients with a BVT indicating a viral infection, comparing it to the adjudicated diagnosis. Results Our study cohort included 38 pediatric patients. Of these, 17 received a viral score, 7 an equivocal score, and 14 a bacterial score. Among those with a viral score, clinical adjudication confirmed a viral etiology in 15 patients (88.2%), while 2 were adjudicated as bacterial. Excluding equivocal scores, the BVT demonstrated a sensitivity of 88%, specificity of 86%, positive predictive value of 88%, and negative predictive value of 86% for viral infections. Notably, despite having both a viral score and adjudicated viral etiology, 53% of patients (9/17) still received a complete course of antibiotics. Conclusion Our findings indicate that the BVT demonstrates good sensitivity and high positive predictive value for identifying viral infections in our pediatric cohort. This suggests its potential as a valuable tool to guide clinical decision-making and promote antibiotic stewardship. Even when the BVT indicated a viral infection, a significant proportion of patients received unnecessary antibiotics. Further studies are needed to explore how the BVT can be best integrated into clinical practice to optimize antibiotic use and improve patient outcomes.