Multiplex PCR-based epidemiology of viral acute respiratory infections in hospitalized children: implications for antibiotic stewardship in Saudi Arabia

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Background Acute respiratory infections (ARIs) remain a leading cause of paediatric hospitalization worldwide. However, data describing viral epidemiology and management patterns in the Middle East remain limited. Objectives To describe the epidemiology, clinical characteristics, monthly viral distribution, treatment practices, and antibiotic utilization patterns among hospitalized children with acute viral respiratory illness during the peak respiratory virus period. Methods This retrospective observational study included 421 children younger than 14 years admitted to a tertiary care hospital in Saudi Arabia with febrile respiratory illness between October 2024 and February 2025. Demographic, clinical, laboratory, treatment, and multiplex respiratory PCR results were analysed. Statistical significance was set at p ≤ 0.05. Results The mean age was 3.2 ± 2.9 years, and 58.2% were male. Overall, 42.8% required supplemental oxygen and 12.1% required ICU admission. Respiratory pathogens were detected in 72.9% of patients. The most common viruses were respiratory syncytial virus (RSV) (35.5%) and Enterovirus (22.1%). Viral positivity was significantly associated with younger age, longer hospital stays, and increased oxygen requirement. Inflammatory markers (CRP and ESR) and antibiotic use were significantly higher in patients with negative swab results ( p < 0.05). RSV showed a marked seasonal peak in November, while Enterovirus circulated throughout the study period. Conclusion RSV and Enterovirus were the predominant causes of paediatric ARI hospitalization during the winter in Saudi Arabia. Early viral identification using multiplex PCR may reduce unnecessary antibiotic use and improve antimicrobial stewardship. these findings support continued regional viral surveillance to guide seasonal preparedness and clinical management

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