Rapid diagnostic tests for infectious diseases in the emergency department

Abstract

36Background: Rapid diagnostic tests (RDTs) for infectious diseases, with a turn-around time 37 <2 hours, are promising tools that could improve patient care, antimicrobial stewardship and 38 infection prevention in the emergency department (ED) setting. Numerous RDTs have been 39 developed but not necessarily for the ED environment. Their successful implementation in 40 the ED relies on their performance and impact on patient management. 41Objectives: The aim of this narrative review is to provide an overview of currently available 42RDTs for infectious diseases in the ED. 43 Sources: PubMed was searched through August 2019 for available studies on RDTs for 44 infectious diseases. Inclusion criteria included: commercial tests approved by the FDA or CE-45 IVD with data on clinical samples, ability to run on fully-automated systems and result 46 delivery within 2 hours. 47 Content: A non-exhaustive list of representative commercially available FDA or CE approved 48 assays was categorized by clinical syndrome: pharyngitis and upper respiratory tract 49 infection, lower respiratory tract infection, gastrointestinal infection, meningitis and 50 encephalitis, fever in the returning traveler and sexually-transmitted infection including HIV. 51 The performance of tests was described based on clinical validation studies. Further, their 52 impact on clinical outcomes and anti-infective use was discussed with a focus on ED-based 53 studies. 54 Implications: Clinicians should be familiar with the distinctive features of each RDT and 55 individual performance characteristics for each target. Their integration into ED workflow 56 should be pre-planned considering local constraints of given settings. Additional clinical 57 studies are needed to further evaluate their clinical and cost effectiveness. 58 345 17. Pierce VM, Elkan M, Leet M, McGowan KL, Hodinka RL. Comparison of the Idaho Technology FilmArray 346 system to real-time PCR for detection of respiratory pathogens in children. J Clin Microbiol 2012;50:364-347 71. 348 18. Loeffelholz MJ, Pong DL, Pyles RB, Xiong Y, Miller AL, Bufton KK, et al. Comparison of the FilmArray 349 Respiratory Panel and Prodesse real-time PCR assays for detection of respiratory pathogens. J Clin 350 Nasopharyngeal Swabs. J Clin Microbiol 2018;56. 357 21. Pancholi P, Kelly C, Raczkowski M, Balada-Llasat JM. Detection of toxigenic Clostridium difficile: 358 comparison of the cell culture neutralization, Xpert C. difficile, Xpert C. difficile/Epi, and Illumigene C. 359 difficile assays. J Clin Microbiol 2012;50:1331-5. 458 Legionella FIA and BinaxNOW(R) Legionella urinary antigen card in two national reference centers. Eur J 459 Clin Microbiol Infect Dis 2015;34:1803-7. 460 59. Sinclair A, Xie X, Teltscher M, Dendukuri N. Systematic review and meta-analysis of a urine-based 461 pneumococcal antigen test for diagnosis of community-acquired pneumonia caused by Streptococcus 462 pneumoniae. J Clin Microbiol 2013;51:2303-10. 463 60. Matta M, Kernéis S, Day N, Lescat M, Hoi AB, Varon E, Gutmann L, Main...

Current and Future Point-of-Care Tests for Emerging and New Respiratory Viruses and Future Perspectives

“…The diagnosis of most of these viruses is based on molecular techniques that can only be performed at specialized referral centers. Recently, there has been increased interest in using POCTs in other settings, such as emergency departments, although implementation might be hampered by the need for specific training (Bouzid et al, 2020). NAATs have higher sensitivity than immunochromatographic assays, but generally, they require a higher degree of technical skills and training (Drancourt et al, 2016).…”

Syndromic panels or the panels' syndrome? A perspective through the lens of respiratory tract infections: author's response

“…Clinicians should also be aware that clinical validation studies have assessed the performance of some respiratory panels with suboptimal approaches and reported cumulative performance results or positive and negative percentage agreement as surrogates of sensitivity and specificity [10]. Notably, certain panels encompass bacterial targets that have been validated with fewer than ten positive samples, and performance has sometimes been reported to be lower than that for viral targets [10]. Thus, clinicians should be particularly attentive when interpreting cumulative performance results or percentage agreement values, which may represent an important and underappreciated limitation.…”

Current and Future Trends in the Laboratory Diagnosis of Sexually Transmitted Infections

“…POC tests based on the detection of pathogen nucleic acids (NAs), antigens, or even antibodies have been developed for a variety of infectious diseases [13,28]. Regarding STIs, POC tests are available for CT [29], NG [30], and TV [31], for example.…”

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