Clinical Impact of Molecular Testing for Respiratory Viruses in Children Admitted with Acute Respiratory Diseases: Real-World Evidence

Aim: To describe the impact of molecular testing for respiratory viruses (MTRV) integrated in an antimicrobial and diagnostic stewardship program analyzing antimicrobial prescription and length of stay (LOS) of children hospitalized with acute respiratory disease in a resource-limited setting. Methods: A retrospective case-control study was designed involving children hospitalized with acute respiratory disease. Interventions in the case group included implementation of MTRV in a 24 h clinical microbiology service, results available during the first day of hospitalization, training technicians and medical staff in sampling, results interpretation, supervisions and recommendation about antibiotic prescriptions by pediatric infectious diseases and pneumologist. Main outcomes were mean LOS, antibiotic prescriptions and days of therapy (DOT). Results: A total of 1200 children were included (396 cases and 804 controls), most of whom were younger than 5 years. Median LOS was shorter in the case group (5 vs 6 days; p≤0.05), with a 17.1% increase in hospitalizations lasting 1-4 days and a reduction in stays of 5-10 days (p<0.001). Antibiotic prescription was significantly lower in cases from day 1 (34.5% vs 81.0%; p<0.001) and remained lower on days 3 and 5. Viral detection on the first hospital day was associated with up to a 20% reduction in antibiotic use. We observed a reduction in DOTs/100 days for aminopenicillins with beta-lactamase inhibitors, third-generation cephalosporins, and macrolides (p<0.001). Viruses were detected in 66.4% of cases, mainly rhinovirus/enterovirus, RSV, SARS-CoV-2, and parainfluenza virus type 3. Conclusion: The integration of MTRV testing into a stewardship program reduced antibiotic use and shortened hospital stays in children with acute respiratory disease. Supporting the value of rapid molecular diagnostics as a key component of pediatric antimicrobial stewardship, especially in resource-limited settings.