An Overview of Emerging Point-of-Care Tests for Differentiating Bacterial and Viral Infections

Abstract


 Antimicrobial resistance is an important health concern in Canada and around the world. Although resistance arises naturally, the overuse of antibiotics, among many other behavioural, social, and economic drivers, contributes to the emergence of resistance patterns. Within health care settings, diagnostic uncertainty, a situation in which it is uncertain whether a suspected infection is due to a bacterial, viral, or other microorganism, is a regarded as a key driver that contributes to overuse of antibiotics. In these situations, antibiotics may be prescribed although the infection is viral.
 Emerging health technologies that can help reduce diagnostic uncertainty of acute infections at the point of care may help reduce the unnecessary use of antibiotics. If these point-of-care diagnostic devices demonstrate clinical benefit and cost-effectiveness for health systems, they may complement other interventions as part of antibiotic stewardship programs.
 This Horizon Scan provides an overview of new and emerging point-of-care tests that help differentiate bacterial and viral infections. Although rapid tests for identifying specific pathogens have existed for decades, these emerging tests aim to assess a wider range of possible pathogens and help inform treatment decisions.
 Different types of emerging devices, such as rapid molecular tests and immunoassays, are described including how they work and information about their capabilities that may influence their potential use. The report also describes the evidence about the diagnostic accuracy of certain tests and their effect on reducing antibiotic prescribing. Considerations are provided about where tests might be beneficial, such as primary care settings, and the emerging evidence base for their feasibility and acceptability.
 The emerging evidence suggests that point-of-care tests could be effective tools as part of antibiotic stewardship programs, but further studies assessing specific devices in randomized controlled trials are recommended by researchers and health technology assessment agencies. Monitoring the continued development of devices and the testing landscape, especially in post-pandemic health care, will be important for decision-makers.