Evaluation of a two-stage testing algorithm for the diagnosis of respiratory viral infections

Gardiner, Bradley J.; Parker, Carmella; Rabson, Arthur R.; Snydman, David R.; Doron, Shira

doi:10.1016/j.diagmicrobio.2018.03.007

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…Another study, using a decision-analysis approach in a pediatric patient population, concluded that testing using the Luminex xTag respiratory virus panel NAAT was less costly than other testing strategies when the prevalence of infection was ≥11%, with savings being primarily due to a reduction in the duration of hospitalization (58). Other groups have demonstrated potential laboratory cost savings associated with syndromic respiratory virus testing (59, 60) or a two-stage algorithm involving Quidel Sofia influenza antigen testing with reflex testing of negative samples with the BioFire FilmArray system (61). The contributions of the myriad coinfections diagnosed by syndromic testing to cost-effective respiratory virus testing remain an area of active investigation.…”

Section: Testing Methodsmentioning

confidence: 99%

Cost-Effective Respiratory Virus Testing

Pinsky

Hayden

2019

J Clin Microbiol

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The timely and accurate diagnosis of respiratory virus infections has the potential to optimize downstream (posttesting) use of limited health care resources, including antibiotics, antivirals, ancillary testing, and inpatient and emergency department beds. Cost-effective algorithms for respiratory virus testing must take into consideration numerous factors, including which patients should be tested, what testing should be performed (for example, antigen testing versus reverse transcription-PCR testing or influenza A/B testing versus testing with a comprehensive respiratory virus panel), and the turnaround time necessary to achieve the desired posttesting outcomes. Despite the clinical impact of respiratory virus infections, the cost-effectiveness of respiratory virus testing is incompletely understood. In this article, we review the literature pertaining to the cost-effectiveness of respiratory virus testing in pediatric and adult patient populations, in emergency department, outpatient, and inpatient clinical settings. Furthermore, we consider the cost-effectiveness of a variety of testing methods, including rapid antigen tests, direct fluorescent antibody assays, and nucleic acid amplification tests.

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Section: Testing Methodsmentioning

confidence: 99%

Cost-Effective Respiratory Virus Testing

Pinsky

Hayden

2019

J Clin Microbiol

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Syndromic Multiplex Polymerase Chain Reaction (mPCR) Testing and Antimicrobial Stewardship: Current Practice and Future Directions

Rader

Stevens

Bearman

2021

Curr Infect Dis Rep

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Purpose of Review Syndromic multiplex polymerase chain reaction (mPCR) panels offer the antimicrobial steward a rapid tool for optimizing and de-escalating antimicrobials. In this review, we analyze the role of syndromic mPCR in respiratory, gastrointestinal, and central nervous system infections within the context of antimicrobial stewardship efforts. Recent Findings For all mPCR syndromic panels, multiple studies analyzed the pre-and-post implementation impact of mPCR on antimicrobial utilization. Prospective studies and trials of respiratory mPCR stewardship interventions, including diagnostic algorithms, educational efforts, co-testing with procalcitonin, and targeted provider feedback currently exist. For gastrointestinal and cerebrospinal fluid mPCR, fewer peer-reviewed reports exist for the use of mPCR in antimicrobial stewardship. These studies demonstrated an inconsistent trend towards decreasing antibiotic use with mPCR. This is further limited by a lack of statistical significance, the absence of controlled, prospective trials, and issues with data generalizability. Summary Antibiotic overuse may improve when mPCR is coupled with electronic medical record algorithm-based approaches and direct provider feedback by an antimicrobial stewardship professional. mPCR may prove a useful tool for antimicrobial stewardship but future studies are needed to define the best practice for its utilization.

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Impact of BioFire FilmArray respiratory panel results on antibiotic days of therapy in different clinical settings

Manatrey-Lancaster

Bushman

Caligiuri

et al. 2021

ASHE

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Objective: The BioFire FilmArray Respiratory Panel (RFA) has been proposed as a tool that can aid in the timely diagnosis and treatment of respiratory tract infections but its effect on antibiotic prescribing among adult patients has varied. We evaluated the impact of RFA result on antibiotic days of therapy (DOTs) in 2 distinct cohorts: hospitalized patients and patients discharged from the emergency department (ED). Design: Retrospective cohort study. Setting: The study was conducted in 3 community hospitals in Des Moines, Iowa, from March 3 to March 16, 2019. Patients: Adults aged >18 years. Methods: Potential outcome means and average treatment effects for RFA results on antibiotic DOTs were estimated. Inverse probability of treatment weighting with regression adjustment was used. Results: We identified 243 patients each in the hospitalized and ED-discharged cohorts. Among hospitalized patients, RFA results did not affect antibiotic DOTs. Among patients discharged from the ED, we found that if all patients had had influenza detected, the average DOTs would have been 2.3 DOTs (−3.2 to −1.4) less than the average observed if all the patients had had a negative RFA (P < .0001); no differences in DOTs were observed when comparing an RFA with a noninfluenza virus detected compared to an RFA with negative results. Conclusions: The impact of RFA results on antibiotic DOTs varies by clinical setting, and reductions were observed only among patients discharged from the ED who had influenza A or B detected.

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Evaluation of a two-stage testing algorithm for the diagnosis of respiratory viral infections

Cited by 3 publications

References 17 publications

Cost-Effective Respiratory Virus Testing

Cost-Effective Respiratory Virus Testing

Syndromic Multiplex Polymerase Chain Reaction (mPCR) Testing and Antimicrobial Stewardship: Current Practice and Future Directions

Impact of BioFire FilmArray respiratory panel results on antibiotic days of therapy in different clinical settings

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