Availability of diagnostic tools and stewardship protocols for managing infectious diseases in Italian paediatric emergency departments: a nationwide survey.

Abstract

BACKGROUND: Infectious diseases are a leading cause of Paediatric Emergency Department (PED) visits worldwide, characterised by significant clinical variability in both presentation and severity. Literature highlights that infection biomarkers and rapid etiological tests, when integrated into standardised clinical protocols, are essential for timely diagnosis and appropriate treatment, reducing misdiagnosis and antibiotic misuse. However, these tools are not consistently available in Italian PEDs. The objective of this survey is to assess the availability of diagnostic tools and current diagnostic practices in Italian PEDs, focusing on infection biomarkers, Point-of-Care (PoC) technologies, and the presence of disease-specific antimicrobial stewardship protocols. METHODS: A cross-sectional survey, in collaboration with the Italian Society of Paediatric Emergency Medicine (SIMEUP), was conducted among clinicians working in PEDs across Italy. An online questionnaire was submitted at one referent for each centre, collecting data about each hospital activity, availability of diagnostic biomarkers, the use of PoC technologies, microbiological test reporting times, and availability of disease-specific protocols. RESULTS: Data were collected from 55 PEDs representing almost all Italian regions, with a predominance of first- and second-level centres. Venous blood sampling was the primary method for investigating febrile children (80%), while only 20% of centres used capillary sampling as the initial diagnostic method. Limited access to PoC technologies for capillary samples (blood count and C-reactive protein available in 27.3%) contributed to this preference. Except for the SARS-CoV-2 nasopharyngeal swab (85% of PEDs), other PoC microbiological tests were less frequently available, making rapid etiological diagnosis more difficult. Laboratory-based microbiological tests were widely available (blood cultures, 93%; culture testing on specific samples, 84%; nasal swabs for influenza, 84%), but they often had reporting times exceeding 48 hours, which delays clinical decisions. Only 3.6% of centres had formal antibiotic prescription and de-escalation protocols, possibly leading to variability in clinical practice and overuse of antibiotics. CONCLUSIONS: This study highlights the fragmentation of diagnostic resources and practices in Italian PEDs, particularly in first-level centres. There is a clear need to expand access to PoC technologies, reduce test reporting times, and implement standardised protocols to improve diagnostic accuracy and enhance antibiotic stewardship.