{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:36:52Z","timestamp":1785411412786,"version":"3.56.0"},"reference-count":79,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017958","name":"Research of Health Commission of Hubei Province","doi-asserted-by":"publisher","award":["WJ2025Z010"],"award-info":[{"award-number":["WJ2025Z010"]}],"id":[{"id":"10.13039\/100017958","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017958","name":"Research of Health Commission of Hubei Province","doi-asserted-by":"publisher","award":["WJ2021M262"],"award-info":[{"award-number":["WJ2021M262"]}],"id":[{"id":"10.13039\/100017958","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Medical Research Project of Wuhan Health Commission","award":["WX23A90"],"award-info":[{"award-number":["WX23A90"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["32270528"],"award-info":[{"award-number":["32270528"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["32270528"],"award-info":[{"award-number":["32270528"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"2024 Hunan Province Graduate Research Innovation Project","award":["CX20240883"],"award-info":[{"award-number":["CX20240883"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Pediatric respiratory infections remain among the leading causes of emergency department visits, hospitalization and pediatric intensive care unit (PICU) admission. Although most acute respiratory infections in children are viral, clinical manifestations overlap substantially among viral, bacterial and atypical pathogens, creating diagnostic uncertainty and promoting empirical antimicrobial use. Rapid antigen tests, nucleic acid amplification tests, multiplex respiratory panels and metagenomic sequencing have expanded the ability to detect pathogens within clinically actionable timeframes. However, evidence from pediatric emergency trials indicates that rapid pathogen detection alone does not necessarily reduce antibiotic prescribing or healthcare costs. These findings suggest that the value of rapid diagnostics depends less on analytical breadth than on whether testing is applied to the right child, in the right clinical scenario and within a predefined decision pathway. This narrative review reorganizes the evidence around a scenario-driven top-pathogen framework. Top pathogens are defined as organisms that, in a specific age group, syndrome, season or care setting, have high prevalence, severe disease potential, transmissibility, treatment implications, antimicrobial resistance relevance or infection-control value. We discuss how top-pathogen testing should differ across emergency triage, inpatient ward management, severe pneumonia, PICU care, hospital-acquired pneumonia, ventilator-associated pneumonia and outbreak settings. We further examine the economic mechanisms through which rapid testing may generate value, including reduced unnecessary antibiotics, timely antiviral therapy, optimized isolation, shorter length of stay, reduced repeated testing and prevention of healthcare-associated transmission. Finally, we propose implementation principles centered on diagnostic stewardship, antimicrobial stewardship, local epidemiology and real-world cost-effectiveness evaluation. A scenario-driven top-pathogen strategy may provide a practical bridge between broad syndromic testing and precision infectious disease management in children.<\/jats:p>","DOI":"10.3390\/pathogens15060628","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T09:49:51Z","timestamp":1781257791000},"page":"628","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Scenario-Driven Rapid Testing for Top Pathogens in Pediatric Respiratory Infections: Clinical and Economic Value from Emergency Triage to Precision Anti-Infective Management in the PICU"],"prefix":"10.3390","volume":"15","author":[{"given":"Jiahui","family":"Chen","sequence":"first","affiliation":[{"name":"Sanya Institute of Hunan University of Science and Technology, Hunan University of Science and Technology, Sanya 572024, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"},{"name":"Pediatric Respiratory Disease Laboratory, Institute of Maternal and Child Health, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"},{"name":"Pediatric Respiratory Disease Laboratory, Institute of Maternal and Child Health, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuyi","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"},{"name":"Pediatric Respiratory Disease Laboratory, Institute of Maternal and Child Health, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"},{"name":"Pediatric Respiratory Disease Laboratory, Institute of Maternal and Child Health, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9027-7120","authenticated-orcid":false,"given":"Yifei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Sanya Institute of Hunan University of Science and Technology, Hunan University of Science and Technology, Sanya 572024, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxia","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"},{"name":"Pediatric Respiratory Disease Laboratory, Institute of Maternal and Child Health, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.cmi.2016.02.004","article-title":"Prevalence, codetection and seasonal distribution of upper airway viruses and bacteria in children with acute respiratory illnesses with cough as a symptom","volume":"22","author":"Grimwood","year":"2016","journal-title":"Clin. 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