Impact of a Rapid Respiratory Panel Test on Patient Outcomes

Rogers, Beverly Barton; Shankar, Prabhu Rv; Jerris, Robert C.; Kotzbauer, David; Anderson, Evan J.; Watson, James R.; O’Brien, Lauren; Uwindatwa, Francine; McNamara, Kelly; Bost, James E.

doi:10.5858/arpa.2014-0257-oa

Cited by 220 publications

(217 citation statements)

References 7 publications

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“…It has been shown that rapid diagnosis of etiological agents can result in the reduction or optimization of antimicrobial therapy (24)(25)(26). In one study of 143 children who tested positive for adenovirus in direct fluorescent assays or viral cultures, 36% demonstrated a change in management, including discontinuation of antimicrobial agents and/or discharge from the hospital (24).…”

Section: Discussionmentioning

confidence: 99%

Impact of a Rapid Herpes Simplex Virus PCR Assay on Duration of Acyclovir Therapy

et al. 2017

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Herpes simplex virus (HSV) infections of the central nervous system (CNS) are associated with significant morbidity and mortality rates in children. This study assessed the impact of a direct HSV (dHSV) PCR assay on the time to result reporting and the duration of acyclovir therapy for children with signs and symptoms of meningitis and encephalitis. A total of 363 patients with HSV PCR results from cerebrospinal fluid (CSF) samples were included in this retrospective analysis, divided into preimplementation and postimplementation groups. For the preimplementation group, CSF testing was performed using a laboratory-developed real-time PCR assay; for the postimplementation group, CSF samples were tested using a direct sampleto-answer assay. All CSF samples were negative for HSV. Over 60% of patients from both groups were prescribed acyclovir. The average HSV PCR test turnaround time for the postimplementation group was reduced by 14.5 h (23.6 h versus 9.1 h; P Ͻ 0.001). Furthermore, 79 patients (43.6%) in the postimplementation group had dHSV PCR results reported Ͻ4 h after specimen collection. The mean time from specimen collection to acyclovir discontinuation was 17.1 h shorter in the postimplementation group (31.1 h versus 14 h; P Ͻ 0.001). The median duration of acyclovir therapy was also significantly reduced in the postimplementation group (29.2 h versus 14.3 h; P ϭ 0.01). Our investigation suggests that implementation of rapid HSV PCR testing can decrease turnaround times and the duration of unnecessary acyclovir therapy.KEYWORDS HSV, acyclovir, encephalitis, herpes simplex virus, meningitis, rapid diagnosis, toxicity H erpes simplex viruses (HSVs) are important causes of meningitis and encephalitis, particularly among children and immunocompromised patients (1). The HSV infection rate among neonates is estimated to be 1 case per 32,000 deliveries, and approximately 1,500 cases of neonatal HSV disease occur annually in the United States (2, 3). Prompt initiation of antiviral therapy is paramount, as mortality rates for disseminated neonatal infections can be as high as 80% if the infections are left untreated; 70% of survivors are left with detrimental neurological sequelae (4-6).Patients with HSV meningitis and encephalitis typically have initial presentations of headache, fever, and altered mental status. However, neonates with HSV central nervous system (CNS) infections may have nonspecific presentations, including lethargy, irritability, poor oral intake, and temperature instability (7). Cutaneous vesicular lesions may be indicative of HSV infections in infants, but the absence of vesicular rash does not preclude neonatal HSV CNS infection in 35% of cases (8). Other infectious etiologies associated with CNS infections can present with similar symptoms (9). Thus, laboratory testing of cerebrospinal fluid (CSF) samples is necessary to confirm the diagnoses.

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Section: Discussionmentioning

confidence: 99%

Impact of a Rapid Herpes Simplex Virus PCR Assay on Duration of Acyclovir Therapy

et al. 2017

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“…In this concept, the costs of a test are multiplied by the turnaround time and therefore represent the impact of implementing a POC test. POC tests can only have an impact on antimicrobial therapy and patient management if results are timely available, interpreted, and followed-up by a medical specialist [21,22]. When implemented, it increases the probability of a correct (preliminary) diagnosis -including the reduced need for further diagnostics, streamline antimicrobial treatment sooner if needed (thereby also minimizing the risk for toxicity), and improve infection prevention measurements.…”

Section: Importance Of Diagnosticsmentioning

confidence: 99%

Measuring the impact of antimicrobial stewardship programs

Dik

Hendrix

Poelman

et al. 2016

Expert Review of Anti-infective Therapy

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Antimicrobial Stewardship Programs (ASPs) are being implemented worldwide to optimize antimicrobial therapy, and thereby improve patient safety and quality of care. Additionally, this should counteract resistance development. It is, however, vital that correct and timely diagnostics are performed in parallel, and that an institution runs a well-organized infection prevention program. Currently, there is no clear consensus on which interventions an ASP should comprise. Indeed this depends on the institution, the region, and the patient population that is served. Different interventions will lead to different effects. Therefore, adequate evaluations, both clinically and financially, are crucial. Here, we provide a general overview of, and perspective on different intervention strategies and methods to evaluate these ASP programs, covering before mentioned topics. This should lead to a more consistent approach in evaluating these programs, making it easier to compare different interventions and studies with each other and ultimately improve infection and patient management. ARTICLE HISTORY

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“…Sofia and Veritor have demonstrated improved antigen detection capabilities in this area. An evaluation of FDA-cleared rapid antigen tests to detect 7 different clinical isolates of influenza A variant H3N2 [(H3N2)v] virus showed that only four of seven assays, including both Sofia and Veritor, detected all strains (23). Likewise, for the novel avian origin influenza A (H7N9) virus, the limits of detection (LODs) were lowest for Veritor and Sofia among six rapid antigen tests (24), and in serial respiratory specimens collected from a patient with H7N9 infection, Veritor was positive in more samples than four other rapid antigen assays, including Sofia and the direct fluorescent-antibody assay (DFA) (25).…”

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confidence: 99%

“…Diagnostic accuracy has been shown to reduce ancillary testing, assist in decisions to admit or not admit, and facilitate appropriate therapeutic decisions (antiviral, antibiotic, or none). Incorrect treatment is expensive and can result in greater risk of toxicity, adverse effects, and development of drug resistance (21)(22)(23). Optimal test performance is essential for infection control to reduce the risk of nosocomial outbreaks and their associated morbidity and mortality and to reduce the significant costs to health care systems, including health care worker (HCW) absenteeism, medication costs, and staff time spent in outbreak control.…”

mentioning

confidence: 99%

“…Delays in results lead to additional ancillary testing and prolonged hospital stays. The study by Rodgers et al determined that a positive viral test result decreased the inpatient length of stay and time in isolation (23). Cost savings were estimated at $231 in hospital costs, $17 in antibiotic usage per patient, and $178 per patient for testing if a panel of various PCRs had to be run in lieu of the single rapid comprehensive respiratory panel.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Point-Counterpoint: Can Newly Developed, Rapid Immunochromatographic Antigen Detection Tests Be Reliably Used for the Laboratory Diagnosis of Influenza Virus Infections?

Dunn

Ginocchio

2015

J Clin Microbiol

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Impact of a Rapid Respiratory Panel Test on Patient Outcomes

Abstract: The RRP decreases the duration of antibiotic use, the length of inpatient stay, and the time in isolation.

Cited by 220 publications

References 7 publications

Impact of a Rapid Herpes Simplex Virus PCR Assay on Duration of Acyclovir Therapy

Impact of a Rapid Herpes Simplex Virus PCR Assay on Duration of Acyclovir Therapy

Measuring the impact of antimicrobial stewardship programs

Point-Counterpoint: Can Newly Developed, Rapid Immunochromatographic Antigen Detection Tests Be Reliably Used for the Laboratory Diagnosis of Influenza Virus Infections?

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