Clinical impact of the rapid molecular detection of RSV and influenza A and B viruses in the emergency department

Abstract

Introduction Using respiratory virus rapid diagnostic tests in the emergency department could allow better and faster clinical management. Point-of-care PCR instruments now provide results in less than 30 minutes. The objective of this study was to assess the impact of the use of a rapid molecular diagnostic test, the cobas® Influenza A/B & RSV Assay, during the clinical management of emergency department patients. Methods Patients (adults and children) requiring admission or suffering from an underlying condition at risk of respiratory complications were prospectively recruited in the emergency department of four hospitals in the Brussels region. Physicians’ intentions regarding admission, isolation, antibiotic, and antiviral use were collected before and after performing the rapid molecular test. Additionally, a comparison of the analytical performance of this test against antigen rapid tests and viral culture was performed as well as a time-to-result evaluation. Results Among the 293 patients recruited, 90 had a positive PCR, whereas 44 had a positive antigen test. PCR yielded a sensitivity of 100% for all targets. Antigen tests yielded sensitivities ranging from 66.7% for influenza B to 83.3% for respiratory syncytial virus (RSV). The use of PCR allowed a decrease in the overall need for isolation and treatment by limiting the isolation of negative patients and antibiotic use for positive patients. Meanwhile, antiviral treatments better targeted patients with a positive influenza PCR. Conclusion The use of a rapid influenza and RSV molecular test improves the clinical management of patients admitted to the emergency department by providing a fast and reliable result. Their additional cost compared to antigen tests should be balanced with the benefit of their analytical performance, leading to efficient reductions in the need for isolation and antibiotic use.

Point-of-care lung ultrasound predicts hyperferritinemia and hospitalization, but not elevated troponin in SARS-CoV-2 viral pneumonitis in children

“…Viral testing may for some centers be something of a moving target. Point-of-care PCR has been demonstrated to improve ED care for RSV and influenza 43 . Antigen tests in general have significant performance problems unless the prevalence is high 44 , 45 .…”

Surveillance of the respiratory syncytial virus outside infancy: impact of testing methods, a retrospective observational study

“…The multiplication of rapid detection methods for respiratory viruses, ranging from antigen tests [ 5 ] to rapid point-of-care multiplex PCRs [ 6 ] has allowed for a broader detection of RSV. However, this can also complicate its surveillance.…”

“…Although antigen testing can be used in infants due to its relative cost-effectiveness, this method is inaccurate in older patients [ 5 ]. Patients requiring hospitalisation should benefit from more expensive rapid multiplex PCRs to allow better clinical management and relevant hygiene precautions [ 6 ]. As shown in this study, the intertwinement of influenza, RSV and probably SARS-CoV-2 could clinically justify the systematic use of such multiplex PCRs during the epidemic season.…”

“…However, monitoring the number of RSV cases can be tricky because of 1) the difference in sensitivity of the affordable antigen testing between adults and infants [ 5 ]; 2) a probable lack of access to PCR tests; as well as 3) the disregard by clinicians of the impact of this pathogen in adults. Furthermore, 4) the molecular detection of RSV is frequently paired with the detection of other respiratory viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and/or influenza viruses [ 6 ], potentially adding another confusion bias in its surveillance. The aim of this study was to examine the testing data coming from a single large clinical microbiology laboratory for five hospitals in Brussels and to assess the impact of diagnostic methods on the surveillance of RSV during the winter of 2022–2023.…”

Late diagnosis of respiratory syncytial virus and influenza co-infection during coronavirus disease 2019 pandemic: a case report

“…Numerous studies have shown that rapid and accurate diagnosis of respiratory infections enhances clinical management by adjusting the indications for isolation, antibiotic, and antiviral treatment due to better analytical performances than rapid diagnostic tests during seasonal IAV, IBV and RSV epidemics [ 16 – 18 ].…”