Implementation of a rapid influenza A/B and RSV direct molecular assay improves emergency department oseltamivir use in paediatric patients

Mitchell, Stephanie L.; Chang, Yeh-Chung; Feemster, Kristen A.; Cárdenas, Ana Marı́a

doi:10.1099/jmm.0.000676

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…More appropriate prescription of oseltamivir was already reported by other authors (Xu et al, 2013;Mitchell et al, 2018). In our study, oseltamivir could be confidently avoided in cases in which FA was negative for influenza, resulting in savings of approximately 3000 euros.…”

Section: Discussionsupporting

confidence: 70%

Contribution of the FilmArray Respiratory Panel in the management of adult and pediatric patients attending the emergency room during 2015–2016 influenza epidemics: An interventional study

Busson¹,

Bartiaux

Brahim

et al. 2019

International Journal of Infectious Diseases

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Aim: To evaluate the contribution of a multiplex PCR for respiratory viruses on antibiotic and antiviral prescription, ancillary test prescription, admission and length of stay of patients. Methods: Two hundred ninety-one adult and pediatric patients visiting the emergency department during the 2015-2016 influenza epidemic were prospectively included and immediately tested 24/7 using the FilmArray Respiratory Panel. The results were communicated to the practitioner in charge as soon as they became available. Clinical and biological data were gathered and analyzed. Findings: Results from the FilmArray Respiratory Panel do not appear to impact admission or antibiotic prescription, with the exception of a lower admission rate for children who tested positive for influenza B. Parameters that account for the clinical decisions evaluated are CRP level, white blood cell count, suspected or proven bacterial infection and, for adult patients only, signs of respiratory distress. Length of stay is also not significantly different between patients with a positive and a negative result. A rapid influenza test result permits a more appropriate prescription of oseltamivir.

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Section: Discussionsupporting

confidence: 70%

Contribution of the FilmArray Respiratory Panel in the management of adult and pediatric patients attending the emergency room during 2015–2016 influenza epidemics: An interventional study

Busson¹,

Bartiaux

Brahim

et al. 2019

International Journal of Infectious Diseases

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“…Several studies have described the improvement of appropriate prescription of oseltamivir. 13 In agreement with our results, among adults, the implementation of rapid molecular diagnostic methods contributed to a more targeted administration of oseltamivir, decreasing unnecessary antiviral use. 14 Additionally, reduction of the oseltamivir use in patients with negative influenza test results in less side effects, and decrease of length of hospital stay and associated costs.…”

Section: Discussionsupporting

confidence: 90%

Use of point‐of‐care molecular tests reduces hospitalization and oseltamivir administration in children presenting with influenza‐like illness

Dimopoulou

Vourli

Douros

et al. 2020

Journal of Medical Virology

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Influenza is associated with increased morbidity, healthcare costs, hospitalization rates, and mortality in children. Rapid immunochromatography assay (ICA), a test with low sensitivity, is often used as point‐of‐care (POC) test. Recently, the rapid syndromic molecular test FilmArray has become available. This observational study aims to evaluate whether the use of FilmArray would decrease the use of antivirals and hospitalization rates among children presenting to the emergency room (ER) with influenza‐like illness (ILI) symptoms. Nasopharyngeal swabs were prospectively collected from children, aged 0–16 years, presenting with ILI at the ER of a tertiary hospital during the peak endemic period. Patients were allocated to be tested by either FilmArray or ICA. The use of antivirals and hospitalization rates were noted. Logistic regression models were used to investigate the impact of testing methods on decision‐making. Overall, 80 children were included (mean age: 5 years). Admissions were more likely to occur if an ICA test was performed (OR, 3.16; 95% CI, 1.01–9.82; p = .046). Oseltamivir administration was more likely among children who had undergone the ICA test (OR, 4.67; 95% CI, 1.06–20.43; p = .041). The implementation of rapid molecular test had no impact on complementary diagnostic testing or antibacterial prescription. The use of FilmArray significantly reduced both hospitalization and oseltamivir administration in children. Further knowledge on the use of POC tests is required to improve current management of children presenting with ILI and decrease associated healthcare costs.

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“…Small noncomparative studies, within the ED setting alone, have also suggested that utilisation of RPCR may improve oseltamivir prescription. [15,16,21,36] Both our study, in conjunction with the US study and noncomparative studies would support the idea that a RPCR test compared to a MPCR test improves the utilisation of oseltamivir.…”

Section: Discussionsupporting

confidence: 75%

“…[11,[30][31][32][33] Our ndings extend on and are supported by a small number of previous studies that suggested a reduction in antibiotic usage with RPCR testing. [14,[17][18][19]23] In comparison to our study these were are mostly small studies assessing effects on ED metrics and included non-comparative cohort studies [14][15][16] or used historical controls [17][18][19][20][21][22][23] In particular, one trial found antimicrobial stewardship improvement only occurred in their paediatric and not in their adult population. [19] Notably there has been one large, UK hospital-based, open-label randomised controlled trial comparing outcomes of routine RPCR at presentation of respiratory illness versus standard clinical care.…”

Section: Discussionmentioning

confidence: 97%

“…Most of the available data on the effects of rapid in uenza testing on outcomes for people presenting to Emergency Departments include non-comparative cohort studies [14][15][16] or use historical controls. [17][18][19][20][21][22][23] These studies have generally compared a RPCR test to a multiplex PCR (MPCR) test with longer turnaround times. They have suggested the potential for reductions in antibacterial therapy prescription, increased antiviral prescription or effects on admission rates or infection control procedures.…”

Section: Introductionmentioning

confidence: 99%

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Differences in Antibiotic and Antiviral Use in People With Confirmed Influenza: a Retrospective Comparison of Rapid Influenza PCR and Multiplex Respiratory Virus PCR Tests.

Yeung¹,

Thapa²,

Rawlinson

et al. 2020

Preprint

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BACKGROUND Influenza is a highly contagious respiratory virus with clinical impacts on patient morbidity, mortality and hospital bed management. The effect of rapid nucleic acid testing (RPCR) in comparison to standard multiplex PCR (MPCR) diagnosis in treatment decisions is unclear. This study aimed to determine whether RPCR influenza testing in comparison to standard MPCR testing was associated with differences in antibiotic and antiviral (oseltamivir) utilisation and hospital length of stay in emergency department and inpatient hospital settings. METHODS A retrospective cohort study of positive influenza RPCR and MPCR patients was performed utilising data from the 2017 influenza season. Medical records of correlating patient presentations were reviewed for data collection. An analysis of RPCR versus MPCR patient outcomes was performed examining test turnaround time, antibiotic initiation, oseltamivir initiation and hospital length of stay for both emergency department and inpatient hospital stay. Subgroup analysis was performed to assess oseltamivir use in high risk populations for influenza complications. Statistical significance was assessed using Mann-Whitney test for numerical data and Chi-squared test for categorical data. Odds ratio with 95% confidence intervals were calculated where appropriate.RESULTS Overall, 122 RPCR and 362 MPCR positive influenza patients were included in this study. Commencement of antibiotics was less frequent in the RPCR than MPCR cohorts (51% vs 67%; p <0.01, OR 0.52; 95% CI 0.34-0.79). People at high risk of complications from influenza who were tested with the RPCR were more likely to be treated with oseltamivir compared to those tested with the MPCR (76% vs 63%; p = 0.03, OR 1.81; 95% CI 1.07-3.08). Hospital length of stay was not impacted when either test was used in the emergency department and inpatient settings. CONCLUSIONS These findings suggest utilisation of RPCR testing in influenza management can improve antibiotic stewardship through reduction in antibiotic use and improvement in oseltamivir initiation in those at higher risk of complications. Further research is required to determine other factors that may have influenced hospital length of stay and a cost-benefit analysis should be undertaken to determine the financial impact of the RPCR test.

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Implementation of a rapid influenza A/B and RSV direct molecular assay improves emergency department oseltamivir use in paediatric patients

Cited by 8 publications

References 6 publications

Contribution of the FilmArray Respiratory Panel in the management of adult and pediatric patients attending the emergency room during 2015–2016 influenza epidemics: An interventional study

Contribution of the FilmArray Respiratory Panel in the management of adult and pediatric patients attending the emergency room during 2015–2016 influenza epidemics: An interventional study

Use of point‐of‐care molecular tests reduces hospitalization and oseltamivir administration in children presenting with influenza‐like illness

Differences in Antibiotic and Antiviral Use in People With Confirmed Influenza: a Retrospective Comparison of Rapid Influenza PCR and Multiplex Respiratory Virus PCR Tests.

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Implementation of a rapid influenza A/B and RSV direct molecular assay improves emergency department oseltamivir use in paediatric patients

Cited by 8 publications

References 6 publications

Contribution of the FilmArray Respiratory Panel in the management of adult and pediatric patients attending the emergency room during 2015–2016 influenza epidemics: An interventional study

Contribution of the FilmArray Respiratory Panel in the management of adult and pediatric patients attending the emergency room during 2015–2016 influenza epidemics: An interventional study

Use of point‐of‐care molecular tests reduces hospitalization and oseltamivir administration in children presenting with influenza‐like illness

Differences in Antibiotic and Antiviral Use in People With Confirmed Influenza: a Retrospective Comparison of Rapid Influenza&nbsp;PCR and Multiplex Respiratory Virus PCR Tests.

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Differences in Antibiotic and Antiviral Use in People With Confirmed Influenza: a Retrospective Comparison of Rapid Influenza PCR and Multiplex Respiratory Virus PCR Tests.