Multiplex PCR point of care testing versus routine, laboratory-based testing in the treatment of adults with respiratory tract infections: a quasi-randomised study assessing impact on length of stay and antimicrobial use

Abstract

BackgroundLaboratory-based respiratory pathogen (RP) results are often available too late to influence clinical decisions such as hospitalisation or antibiotic treatment due to time delay in transport of specimens and testing schedules. Ward-based i.e. point of care (POC) testing providing rapid results may alter the clinical management pathway.MethodsFilmArray® RP polymerase chain reaction (PCR) systems were placed in three in-patient and out-patient medical areas. Patients presenting with influenza-like illness /upper respiratory tract infection +/− lower RTI were recruited between January–July 2015. FilmArray® POC testing occurred on even days of the month (intervention) or routine, laboratory-based RP PCR testing +/− atypical serology on odd days (control). The primary outcome was length of hospital stay. The secondary outcomes were impact on the use of antimicrobials, readmissions, all-cause mortality, length of ward stay and turn-around time (TAT) (time to result from admission).ResultsOf 606 eligible patients, 545 (89.9%) were included; 211 in the control arm and 334 in the intervention arm. 20% of control arm patients and 24% of intervention arm patients had an RP detected. POC testing was not associated with the primary outcome measure, length of stay, but reduced the TAT from 39.5 h to 19.0 h, p < 0.001. Only the prescribing decision differed between study arms, p < 0.001. When antivirals were given, the intervention was associated with a reduction in the median time to the first dose of 36 h and allowed appropriate treatment of mycoplasma infection.ConclusionsWe found no association between respiratory PCR POC testing and length of stay or most of the secondary outcomes except the antimicrobial prescribing decision. This was probably due to a delay in initiating FilmArray® testing. Despite this, POC testing allowed time-critical antivirals to be given significantly faster, appropriate mycoplasma treatment and results were available considerably faster than routine, laboratory-based testing. Ward-staff of all grades performed POC testing without difficulty suggesting potential use across many divergent healthcare settings. Further studies evaluating the implementation of rapid respiratory PCR POC testing and the effect on length of stay and antimicrobial use are required.Trial registration ISRCTN10470967, Retrospectively Registered, 30/6/2015.

Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

“…Diagnosis of influenza positive patients by POCT resulted in significantly higher rates of antiviral prescription. A number of the studies comparing POC with standard testing attributed the increased antiviral use to faster turnaround time to diagnosis by POCT. Given that antivirals are of most clinical benefit if taken within 48 hours of symptom onset, this is a key point.…”

“…An outcome measuring the proportion of patients treated with brief courses of antibiotics may be more clinically relevant in these cases. At times, molecular POCTs were performed by research investigators rather than clinical staff, suggesting that the study protocol was not initiated immediately upon ED admission. Adoption of new diagnostic technologies will require changes to management protocol and ED collaboration in order to maximise the benefits of improved clinical decision‐making and patient workflow.…”

Multiplex PCR implementation as point-of-care testing in a French emergency department

“…US guidelines specifically recommend use of influenza and multiplex-PCR (mPCR) if these can change the management of hospitalized patients [2]. Patient benefit relies on rapid results turnaround time, and in this regard several kits are suitable for point of care (POC) use [3][4][5]. A few studies have investigated the impact of these tests on prescribing of antiinfectives and length of stay, and their potential cost-effectiveness [3,5].…”

“…Until now, a few studies assessed the impact of a rapid turnaround time for multiplex testing. Most agreed on a global benefit despite their cost ranging from 80 to 140 euros per unit [3][4][5]7]. A recent study in England showed a reduction of £64 per stay, and another in China showed a reduction of $200 per stay [3,5].…”

“…Words count: 788 RSV (n=12 ** ) 9 (75%) 3 (25%) 5 (42%) 3 (25%) 1 (11%) 2 [1][2][3][4][5][6][7][8] Rhinovirus (n=12) 6 (50%) 6 (50%) 3 (33%) 1 (11%) 10 (22%) 3 [2][3][4][5][6][7][8][9] Others (n=9 *** ) 7 (78%) 2 (22%) 8 (88%) 0 (0%) 6 (66%) 6 [0-23] * Including two codetections with RSV and two with a coronavirus. ** Including one codetection with a rhinovirus.…”