Irish journal of medical science · 2026
Diagnostic yield of reflex multiplex PCR after a negative rapid antigen test in children hospitalized with presumed viral acute respiratory tract infection: a prospective cohort study.
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Bedir Ali Zeki, Saf Coşkun, Yörük M Asım
Аннотация
BACKGROUND: Acute respiratory infections, mostly viral, are a leading cause of childhood hospitalization. Rapid antigen tests are fast but cover few viruses; multiplex PCR detects many more. The value of reflex PCR after a negative antigen test is uncertain.
AIMS: To compare the diagnostic yield of antigen testing alone and with reflex multiplex PCR, and to describe the viral spectrum, age associations, and antibiotic exposure.
METHODS: In this single-center prospective cohort, 245 children hospitalized with presumed viral acute respiratory infection (October 2022-October 2023) underwent a five-target rapid antigen test; antigen-negative children had reflex multiplex PCR at the physician's discretion. This was a diagnostic-yield study under partial verification; sensitivity and specificity were intentionally not estimated.
RESULTS: A virus was detected in 140 of 245 children (57.1%); antigen testing alone identified 59 (24.1%). Of 186 antigen-negative children, 99 underwent reflex PCR and 81 (81.8%) were positive (48 with a missed panel-covered virus, 33 with off-panel viruses only). Rhinovirus/enterovirus, not covered by antigen testing, was most frequent (27.9% of identified children). Antibiotics were given to 198 children (80.8%), with no significant difference by viral detection (p = 0.103). Blood cultures and atypical bacterial targets were negative in tested children; typical respiratory bacteria were not systematically investigated.
CONCLUSIONS: A negative antigen test did not exclude a respiratory virus; reflex PCR improved detection, varying by virus and age. With selective testing, the yield is a lower bound. Antibiotic exposure was high regardless of viral detection; its appropriateness could not be judged without systematic bacterial testing.
AIMS: To compare the diagnostic yield of antigen testing alone and with reflex multiplex PCR, and to describe the viral spectrum, age associations, and antibiotic exposure.
METHODS: In this single-center prospective cohort, 245 children hospitalized with presumed viral acute respiratory infection (October 2022-October 2023) underwent a five-target rapid antigen test; antigen-negative children had reflex multiplex PCR at the physician's discretion. This was a diagnostic-yield study under partial verification; sensitivity and specificity were intentionally not estimated.
RESULTS: A virus was detected in 140 of 245 children (57.1%); antigen testing alone identified 59 (24.1%). Of 186 antigen-negative children, 99 underwent reflex PCR and 81 (81.8%) were positive (48 with a missed panel-covered virus, 33 with off-panel viruses only). Rhinovirus/enterovirus, not covered by antigen testing, was most frequent (27.9% of identified children). Antibiotics were given to 198 children (80.8%), with no significant difference by viral detection (p = 0.103). Blood cultures and atypical bacterial targets were negative in tested children; typical respiratory bacteria were not systematically investigated.
CONCLUSIONS: A negative antigen test did not exclude a respiratory virus; reflex PCR improved detection, varying by virus and age. With selective testing, the yield is a lower bound. Antibiotic exposure was high regardless of viral detection; its appropriateness could not be judged without systematic bacterial testing.