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

Abstract

Acute respiratory tract infections are a major cause of morbidity and mortality and represent a significant burden on the health care system. Laboratory testing is required to definitively distinguish infecting influenza virus from other pathogens, resulting in prolonged emergency department (ED) visits and unnecessary antibiotic use. Recently available rapid point-of-care tests (POCT) may allow for appropriate use of antiviral and antibiotic treatments and decrease patient lengths of stay. We undertook a systematic review to assess the effect of POCT for influenza on three outcomes: (1) antiviral prescription, (2) antibiotic prescription, and (3) patient length of stay in the ED. The databases Medline and Embase were searched using MeSH terms and keywords for influenza, POCT, antivirals, antibiotics, and length of stay. Amongst 245 studies screened, 30 were included. The majority of papers reporting on antiviral prescription found that a positive POCT result significantly increased use of antivirals for influenza compared with negative POCT results and standard supportive care. A positive POCT result also led to decreased antibiotic use. The results of studies assessing the effect of POCT on ED length of stay were not definitive. The studies assessed in this systematic review support the use of POCT for diagnosis of influenza in patients suffering an acute respiratory infection. Diagnosis using POCT may lead to more appropriate prescription of treatments for infectious agents. Further studies are needed to assess the effect of POCT on the length of stay in ED.

Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: results from a multicentre retrospective cohort study in The Netherlands

“…Continuation of antibiotics after confirmation of the viral aetiology is not unique to COVID-19 [26,27]. Moreover, randomized controlled studies have not shown a consistent effect of point-of-care testing for influenza on antibiotic prescription rates [28]. Uncertainty avoidance, in this case fear of the possibility of a concurrent or a developing bacterial co-infection, might be too compelling and lead to antibiotic prescription as a coping strategy [27].…”

Rapid Molecular Tests for Influenza, Respiratory Syncytial Virus, and Other Respiratory Viruses: A Systematic Review of Diagnostic Accuracy and Clinical Impact Studies

“…might improve the impact on clinical outcomes as results are available before any initial treatment or management is established by the treating physician. To our knowledge, this is the first review to specifically assess the clinical impact of rapid molecular tests, and not rapid antigen tests, without a restriction in the detection of influenza virus and RSV [45,46]. The included studies, even the high-quality randomized studies [1,20,21,24,25], show heterogeneous results.…”

The Importance of Rapid Influenza Testing in Pediatric Primary Care: Experience During Three Consecutive Influenza Seasons (2016–2019) in Barcelona (Catalonia, Spain)

“…Our results are in line with data published by other groups, like Tillekeratne et al ( 17 ), who showed a 20% decrease in the antibiotic prescription with the use of an POCT for influenza confirmation, and Jennings et al ( 18 ), who showed a five-fold increase of antibiotic prescriptions in clinical diagnosed patients. Egilmezer et al ( 19 ) recently published a systematic review of the impact of diagnosing influenza with a POCT in patients with acute respiratory tract infection. The main findings were that a positive POCT significantly increased the proper use of antivirals and decreased antibiotic prescriptions.…”

“…The main findings were that a positive POCT significantly increased the proper use of antivirals and decreased antibiotic prescriptions. Unfortunately, the number of papers addressing prospectively the impact of influenza POCTs on antibiotic treatment in pediatric primary care were only two out of the 30 papers included in this systematic review ( 19 ). These papers confirm that decision-making process of an antibiotic prescription is vastly influenced by an accurate diagnosis ( 17 , 20 ).…”

“…One of the strengths of our study is that our data are based on the use of a POCT in pediatric primary care, while most of the published data come from emergency services or hospitalized patient cohorts ( 19 ). A limitation of our study was that the data from clinically diagnosed patients without influenza confirmation or patients with fever (Groups 2 and 3) were extracted from the EHR of similar patients visited at other health care centers within the same geographical area, and although the system is capable of detecting any antibiotic prescription or visit to the primary health care system, these data could be higher due to over-the-counter purchased antibiotics or health care visits at private pediatricians or other health care providers.…”