Rapid Diagnostic Tests to Guide Case Management of and Improve Antibiotic Stewardship for Pediatric Acute Respiratory Illnesses in Resource-Constrained Settings: a Prospective Cohort Study in Southwestern Uganda

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dc.contributor.authorCiccone, Emily J.
dc.contributor.authorKabugho, Lydia
dc.contributor.authorBaguma, Emmanuel
dc.contributor.authorMuhindo, Rabbison
dc.contributor.authorJuliano, Jonathan J.
dc.contributor.authorMulogo, Edgar
dc.contributor.authorBoyce, Ross M.
dc.date.accessioned2023-03-22T18:19:55Z
dc.date.available2023-03-22T18:19:55Z
dc.date.issued2021
dc.description.abstractPediatric acute respiratory illness (ARI) is one of the most common reasons for evaluation at peripheral health centers in sub-Saharan Africa and is frequently managed based on clinical syndrome alone. Although most ARI episodes are likely caused by self-limited viral infections, the majority are treated with antibiotics. This overuse contributes to the development of antimicrobial resistance. To evaluate the preliminary feasibility and potential impact of adding pathogen-specific and clinical biomarker diagnostic testing to existing clinical management algorithms, we conducted a prospective, observational cohort study of 225 children presenting with malaria-negative, febrile ARI to the outpatient department of a semi-urban peripheral health facility in southwestern Uganda from October 2019 to January 2020. In addition to routine clinical evaluation, we performed influenza and Streptococcus pneumoniae antigen testing and measured levels of C-reactive protein, procalcitonin, and lactate in the clinic’s laboratory, and conducted a follow-up assessment by phone 7 days later. Almost one-fifth of participants (40/225) tested positive for influenza. Clinical biomarker measurements were low with C-reactive protein of >40 mg/L in only 11% (13/222) of participants and procalcitonin >0.25 ng/mL in only 13% (16/125). All but two children received antibiotic treatment; only 3% (7/225) were admitted. At follow-up, 59% (118/201) of caregivers reported at least one persistent symptom, but fever had resolved for all children. Positive influenza testing was associated with persistent symptoms. In summary, we demonstrate that simple, rapid pathogen-specific testing and biomarker measurement are possible in resource-limited settings and could improve syndromic management and, in turn, antibiotic stewardship.en_US
dc.identifier.citationCiccone, E. J., Kabugho, L., Baguma, E., Muhindo, R., Juliano, J. J., Mulogo, E., & Boyce, R. M. (2021). Rapid diagnostic tests to guide case management of and improve antibiotic stewardship for pediatric acute respiratory illnesses in resource-constrained settings: a prospective cohort study in Southwestern Uganda. Microbiology Spectrum, 9(3), e01694-21.https://doi.org/10.1128/Spectrum.01694-21en_US
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/8280
dc.language.isoenen_US
dc.publisherMicrobiology Spectrumen_US
dc.subjectResource-Constrained Settingsen_US
dc.subjectRapid Diagnostic Testsen_US
dc.subjectAntibiotic Stewardshipen_US
dc.subjectPediatric Acute Respiratory Illnessesen_US
dc.titleRapid Diagnostic Tests to Guide Case Management of and Improve Antibiotic Stewardship for Pediatric Acute Respiratory Illnesses in Resource-Constrained Settings: a Prospective Cohort Study in Southwestern Ugandaen_US
dc.typeArticleen_US
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Rapid Diagnostic Tests to Guide Case Management of and Improve Antibiotic Stewardship for Pediatric Acute Respiratory Illnesses in Resource-Constrained Settings: a Prospective Cohort Study in Southwestern Uganda
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