The epidemiology of pediatric outpatient acute respiratory tract infections in the US: a multi-facility analysis of multiplex PCR testing from 2018 to 2023

Abstract

Post-pandemic, it is essential to understand the epidemiology of pediatric acute respiratory tract infections (ARTIs). Our multi-facility study elucidates the outpatient epidemiology of pediatric ARTI using highly multiplexed PCR testing, providing critical insights into the evolving landscape of the etiological agents with a particular focus on the years following the emergence of SARS-CoV-2. Utilizing data from two different multiplex PCR panels, our research provides a comprehensive analysis of respiratory pathogen positivity from 2018 to 2023. Our findings indicate that over half of the annual test results identified at least one pathogen, primarily of viral origin. Intriguingly, despite the surge in testing during the COVID-19 pandemic, pathogen detection rates remain similar to the pre-pandemic era. These data hold significant implications for directing antimicrobial stewardship strategies, curbing unnecessary antibiotic use in pediatric respiratory diseases, and the value of multiplex PCR testing in the outpatient setting among pediatrics.

Keywords: SARS-CoV-2; antibiotic stewardship; multiplex PCR testing; outpatient epidemiology; pathogen prevalence; pediatric respiratory infections.

FIG 1

Pathogen positivity rate over study time 2018–2023. Graph begins in mid-2018 to censor weeks where no tests were conducted. Individual pathogen positivity at a given time point is represented as the difference between the highest and lowest positivity rate of the corresponding color. Total pathogen positivity at a given time point is represented as the peak pathogen positivity of all colors combined.

FIG 2

Overall positivity rate by season and year.