Evaluating the impact of the multiplex respiratory virus panel polymerase chain reaction test on the clinical management of suspected respiratory viral infections in adult patients in a hospital setting

Abstract

A retrospective cohort design was used to study the impact of a multiplex respiratory virus panel polymerase chain reaction test in 186 adult patients with suspected influenza-like illness. Decisions regarding continuation of empirical antiviral therapy appear to be impacted by the test. However, the impact on reducing antibiotic use remains unclear.

Multiplex Respiratory Virus Testing for Antimicrobial Stewardship: A Prospective Assessment of Antimicrobial Use and Clinical Outcomes Among Hospitalized Adults

“…In agreement with our data, 2 retrospective analyses from Canada showed that influenza virus positivity led to increased use of antivirals, but test results did not correlate with overall antibiotic use [14,22]. Also, 2 European studies found no association between test results and antibiotic use or overall costs [23,24].…”

“…The testing panel targeted influenza A and B viruses, respiratory syncytial virus (RSV) A and B, rhinovirus/enterovirus, parainfluenza virus 1-3, adenovirus, human metapneumovirus, and coronavirus OC43 and 229E. The RVP assay developed at the MUHC was validated as having lower limits of detection for all viruses, compared with those for direct fluorescent antibody and culture [14].…”

“…Studies conducted among pediatric populations have shown that rapid viral testing generally contributes to reducing antibiotic use [8][9][10], but those among adult patients have yielded conflicting results. Small reductions in antibiotic use, shorter durations of hospitalization, and lower overall costs were noted in some studies when test results were communicated to physicians rapidly [11][12][13][14]. However, these were limited by small sample sizes, by comparisons only to historical controls, or by the fact that they only included outpatients-making it difficult to extrapolate their results to acute care hospital settings.…”

Optimizing treatment of respiratory tract infections in nursing homes: Nurse-initiated polymerase chain reaction testing

“…In some acute hospital settings, reporting similar results directly to attending physicians has also not been sufficient to change antibiotic prescribing behaviors. [24][25][26] In hospitals, reporting the PCR result to an AMS team along with specific advice from the AMS team about antibiotic cessation is required to impact prescribing behavior. 24 Slow transfer of information, lack of confidence in the results, and other factors within the nursing homes, such as work flow, resident mix, and prescriber preferences for overly cautious antibiotic prescribing, 27 may have affected the outcome of this study.…”

Influenza and Viral Pneumonia

“…In an observational study, most patients with respiratory tract infection admitted to the hospital who turned out to have an identified viral pathogen did not have their antibiotics discontinued. 107 On the other hand, the use of a clinical pathway integrating the results of viral microbiology testing with clinical findings and procalcitonin testing could have a role in the safe discontinuation of antibiotics. It is now well established that use of procalcitonin to guide initiation and discontinuation of antibiotic in patients with acute respiratory tract infection leads to less use of antibiotics without worsening the outcomes.…”