Impact of Rapid Molecular Detection of Respiratory Viruses on Clinical Outcomes and Patient Management

Abstract

To determine if rapid molecular testing for respiratory viruses in patients with respiratory illnesses can provide advantages to patients and hospitals, rigorous investigations on the impacts of using these assays are required. Well-conducted studies are needed to inform decisions about implementation of new rapid assays to replace standard molecular testing or to initiate testing in laboratories that are currently not doing molecular tests for respiratory viruses due to the complex nature of standard panels. In this issue of the Journal of Clinical Microbiology, N. Wabe et al. (J Clin Microbiol 57:e01727-18, 2019, https://doi.org/10.1128/JCM.01727-18) report the results of their evaluation of the impact of using a rapid molecular test for influenza A/influenza B and RSV on outcomes for adults hospitalized with respiratory illness. The median time from admission to test result of the rapid test was 7.5 h compared to 40.3 h for the standard PCR assay. Compared to the use of the standard molecular assay, use of a rapid test significantly shortened time in the hospital and reduced the number of other microbiology tests performed. The authors concluded that rapid PCR testing of adults hospitalized with respiratory illnesses could provide benefits to both the patients and the hospital. Patients were able to leave the hospital earlier and a greater proportion of them had received their test results before discharge, which would allow appropriate treatment to be provided more quickly.

SAA and CRP are potential indicators in distinction and severity assessment for children with influenza

“…The prevalence rate of influenza A was much higher than that of influenza B, being consistent with previous studies in which influenza A had more ability to cause pandemics than influenza B (Glezen et al, 2013). Moreover, corresponding to reports from other countries (Glezen et al, 2013;Mancinelli et al, 2016;Tran et al, 2016;Mastrolia et al, 2019), this study showed that children with influenza B were more prone to developing bronchitis and pneumonia, suggesting that influenza B positive children were more likely to have lower respiratory tract infection (Kuypers, 2019;Malosh et al, 2018).…”

Missed opportunities to use rapid influenza testing and severity assessment to avoid hospital admission: A cohort study from an East London District General Hospital

“…12 Less sensitive indirect assays are influenza viral antigens tests while others detect neuraminidase activity. The proven benefits of rapid PCR influenza testing in patients presenting to A&E are admission avoidance, 9,[13][14][15] although not in every case series, 16 better use of isolation facilities and reduced nosocomial transmission, 9,[13][14][15] fewer microbiological tests, 15 and a reduction in antimicrobial usage, 9 particularly in the pediatric population. 16 Despite access to near-patient influenza testing, our admission avoidance rates were disappointingly low, possibly because of other factors (eg, frailty or antibiotic requirements) or because the tests were not coupled with a patient pathway or triage decision tool.…”

Management of pneumonia in critically ill patients

“…As a result, respiratory viruses in severe CAP have been reported with increasing frequency. [110][111][112] Additionally, an increase in the age of patients hospitalized for pneumonia is important, as this population is more susceptible to severe viral infection. 60 113 114 Data from a systematic review and meta-analysis from Europe have shown a prevalence of respiratory viruses of between 20% and 25% of CAP cases 115 116 ; these percentages are similar to those reported in studies from the US 110 and Asia.…”