Healthy Child, Happy Parents: Syndromic Testing in the Pediatric Population
Contemporary Pediatrics hosted a podcast with Michael Edmund Watson, MD, PhD, clinical assistant professor of pediatric infectious disease, pediatrics, at University of Michigan Health in Ann Arbor. In this conversation, which has been edited and condensed for clarity, Dr. Watson discusses the clinical utility of syndromic infectious disease testing in the pediatric population.
Dr. Watson is a paid consultant for bioMérieux.
Podcast aired: September 7, 2021
What is the overall value of syndromic testing for both the patient and the pediatric practice?
DR. WATSON: We know that infectious diseases are common causes of hospitalization of children, responsible for approximately 25% of childhood hospital admissions. Of those admissions, about 42% are due to lower respiratory tract infections.
We know that there are multiple pathogens that can cause these serious infectious diseases, and these present with many overlapping features, so it’s not always possible to identify one causative pathogen based on the clinical features alone. This is where syndromic diagnostic testing panels can be helpful. They make our approach more uniform and eliminate some of the guesswork that is required with choosing standalone tests.
How do the fast, comprehensive answers provided by syndromic tests help in the overall care of hospitalized pediatric patients?
DR. WATSON: First off, most pediatric patients are admitted to the hospital are because they’re very sick. And they typically get treated initially with empiric, broad-spectrum antibiotics because the infectious etiology of their condition just isn’t known at the time of admission. We know that not all infections need antimicrobial treatment, especially viral respiratory tract infections and some causes of viral meningitis such as enterovirus.
The use of syndromic testing in these patients is the most effective way to rapidly identify the likely responsible pathogen and aid in antimicrobial stewardship by preventing use of unnecessary antibiotics.
Secondly, syndromic testing can aid in diagnostic stewardship. Having the ability to identify a pathogen with a syndromic panel can reduce the need for unnecessary lab testing, especially invasive procedures that may require sedation or exposure to radiation. These are procedures that can both be expensive and cause unnecessary potential harm to the child.
Third, syndromic testing can help identify those patients with viral infectious who are at low risk of developing serious disease. They can then be discharged more rapidly from the hospital, reducing costs and making beds available for patients who need them more urgently.
There have been studies showing pediatric patients and their parents who receive a definitive diagnosis of a causative infectious disease pathogen are less likely to bounce back for a return trip to the ER. What is the role of multiplex testing in helping providers, patients, and families in avoiding those bounce back trips?
DR. WATSON: In my experience, it does seem to be true that families who receive a diagnosis with an actual named pathogen are more confident in the care that they’ve received and are better equipped to deal with issues that come up after being discharged from the emergency room or the hospital. If the child has subsequent fevers or if fatigue seems to linger longer, those families who don’t receive an actual named diagnosis prior to discharge often become more anxious and end up bouncing back to the ER or asking for a referral to additional specialists. That additional anxiety and those referrals all result in additional healthcare costs, time away from school and work, and even increased risk to the patient due to the need for potentially invasive diagnostic testing.
The use of a multiplex panel can give parents and care providers more information and more confidence in their decisions and allows us to provide parents with anticipatory guidance that they need. It serves as a safety net—what should they look for that might trigger a call back if the situation is not improving?
Has having a multiplex test for respiratory infections impacted your COVID-19 testing?
DR. WATSON: As at many institutions, we really had to bring testing for SARS-CoV-2 online very quickly, and we initially had to use single analyte testing because that’s all that was available. This led to very high utilization of our clinical microbiology lab and took up the vast majority of our molecular diagnostic testing capacity. That really stressed our lab’s ability to perform some other key viral tests that needed the PCR thermal cyclers and other related hardware.
Today, we have access to a multiplex PCR panel that includes SARS-CoV-2, so we have more of an all-in-one solution that has eased the burden on our lab’s capacity. That’s been especially useful in pediatrics given that children and many adolescents had fairly mild presentations of SARS-CoV-2 that could have easily been confused with other common respiratory viruses.
As we’re heading into the end of summer and the start of another fall season, we’re already seeing a surge in multiple parts of the country of several respiratory viruses that we did not see in 2020, including RSV, parainfluenza, and other seasonal respiratory pathogens. With those viruses back in circulation along with the ongoing and evolving SARS-CoV-2 variants, we may be in for a really challenging respiratory viral season. Consequently, syndromic panel testing is going to be vital to help identify and treat patients appropriately and effectively.
What are the 2 or 3 things you’d like the pediatric community to take away from our discussion?
DR. WATSON: The first thing is that use of a syndrome-based multiplex PCR assay can really aid in antimicrobial stewardship. This has been demonstrated multiple times in hospitalized pediatric patients, where the use of the [BIOFIRE® FilmArray® Meningitis/Encephalitis Panel] decreased the time to diagnosis, reduced unnecessary antimicrobial use—especially acyclovir—and ultimately was shown to reduce costs through shorter duration of hospitalization and decreased antimicrobial use.
Secondly, the use of a syndrome-based PCR assay can increase both patient and parent satisfaction, and potentially reduce the need for return visits to the ED or referrals to sub-specialists for second, or even third opinions.
Discover more about syndromic testing for meningitis/encephalitis:
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