Tohoku J. Exp. Med., 2018 December, 246(4)

Implementation of Point-of-Care Molecular Diagnostics for Mycoplasma pneumoniae Ensures the Correct Antimicrobial Prescription for Pediatric Pneumonia Patients

DAISUKE HAYASHI,1 YUSAKU AKASHI,2 HIROMICHI SUZUKI,2 MASANARI SHIIGAI,3 KOJI KANEMOTO,4 SHIGEYUKI NOTAKE,5 TAKUMI ISHIODORI,1 HIROICHI ISHIKAWA4 and HIRONORI IMAI1

1Department of Pediatrics, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
2Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
3Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
4Department of Respiratory Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
5Department of Clinical Laboratory, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan

Mycoplasma pneumoniae is a leading causative pathogen of pneumonia among pediatric patients, and its accurate diagnosis may aid in the selection of appropriate antimicrobial agents. We established a rapid reporting system of a polymerase chain reaction (PCR) examination for M. pneumoniae that enables physicians to obtain test results approximately 90 minutes after ordering the test. In this study, we evaluated the impact of this system on antimicrobial prescriptions for pediatric pneumonia patients after its implementation from May 2016 to April 2017. In total, we identified 375 pediatric pneumonia patients, and the results of the rapid PCR examinations for Mycoplasma pneumoniae were reported immediately in 90.7% of patients (340/375), with physicians able to use these results to decide on patients' management before the prescription of antimicrobial agents. Of the 375 pediatric pneumoniae patients, M. pneumoniae was detected in 223 (59.5%). Among the 223 M. pneumoniae-positive pneumonia cases, antimicrobial agents for atypical pathogens (macrolides, tetracyclines or quinolones) were prescribed in 97.3% (217/223) at the initial evaluation, and their prescription rates increased to 99.1% (221/223) during management. In contrast, antimicrobial agents for atypical pathogens were prescribed only in 10.5% of 152 M. pneumoniae-negative pneumonia cases at the initial evaluations, and only 1 additional case was prescribed clarithromycin for persistent symptoms during management. In conclusion, we show that molecular technology could be applicable in the field of point-of-care testing in infectious disease, and its implementation will ensure the correct antimicrobial prescription for pediatric pneumonia patients.

Key words —— antimicrobial agent; antimicrobial stewardship; Mycoplasma pneumoniae; pneumonia; point-of-care molecular diagnostics

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Tohoku J. Exp. Med., 2018, 246, 225-231

Correspondence: Yusaku Akashi, Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558, Japan.

e-mail: yusaku-akashi@umin.ac.jp