Point of care testing of Influenza A/B and RSV in an adult respiratory assessment unit is associated with improvement in isolation practices and reduction in hospital length of stay

Berry, Louise; Lansbury, Louise; Gale, Lydia; Carroll, Ann Marie; Lim, Wei Shen

doi:10.1099/jmm.0.001187

Cited by 23 publications

(25 citation statements)

References 25 publications

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“…8,10 To our knowledge, very few studies have assessed the impact of rapid molecular testing on patient isolation for respiratory viruses. 14,28 However our study showed a positive impact on compliance with preventive measures by increasing single-room assignment in the downstream unit among patients with a viral infection that requires isolation. These measures are critical for Nineteen patients are missing due to an unknown length of stay; the length of stay for patients still hospitalized on D30 was set at 30 days.…”

Section: Discussionmentioning

confidence: 67%

Added value of rapid respiratory syndromic testing at point of care versus central laboratory testing: a controlled clinical trial

Bouzid

Casalino

Mullaert

et al. 2021

Journal of Antimicrobial Chemotherapy

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Background Virus-associated respiratory infections are in the spotlight with the emergence of SARS-CoV-2 and the expanding use of multiplex PCR (mPCR). The impact of molecular testing as a point-of-care test (POCT) in the emergency department (ED) is still unclear. Objectives To compare the impact of a syndromic test performed in the ED as a POCT and in the central laboratory on length of stay (LOS), antibiotic use and single-room assignment. Methods From 19 November 2019 to 9 March 2020, adults with acute respiratory illness seeking care in the ED of a large hospital were enrolled, with mPCR performed with a weekly alternation in the ED as a POCT (week A) or in the central laboratory (week B). Results 474 patients were analysed: 275 during A weeks and 199 during B weeks. Patient characteristics were similar. The hospital LOS (median 7 days during week A versus 7 days during week B, P = 0.29), the proportion of patients with ED-LOS <1 day (63% versus 60%, P = 0.57) and ED antibiotic prescription (59% versus 58%, P = 0.92) were not significantly different. Patients in the POCT arm were more frequently assigned a single room when having a positive PCR for influenza, respiratory syncytial virus and metapneumovirus [52/70 (74%) versus 19/38 (50%) in the central testing arm, P = 0.012]. Conclusions Syndromic testing performed in the ED compared with the central laboratory failed to reduce the LOS or antibiotic consumption in patients with acute respiratory illness, but was associated with an increased single-room assignment among patients in whom a significant respiratory pathogen was detected.

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Section: Discussionmentioning

confidence: 67%

Added value of rapid respiratory syndromic testing at point of care versus central laboratory testing: a controlled clinical trial

Bouzid

Casalino

Mullaert

et al. 2021

Journal of Antimicrobial Chemotherapy

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“…However, the high cost of hospital molecular platforms, the complexity of the equipment required, the need for trained professionals and the delay of 2–4 h to obtain the results with frequent unavailability on weekends and during the night impaired the use of conventional NAATs for respiratory viral infections such as influenza or SARS‐CoV‐2 diagnosis even in hospital settings. Finally, the implementation of point‐of‐care molecular testing for SARS‐CoV‐2 RNA could deliver benefits to patient care admitted to hospital with COVID‐19‐related respiratory illness in terms of more rapid confirmation of coronavirus infection, a shorter length of stay, more rapid isolation practices of patients tested positive, and shorter turnaround time, as previously shown for influenza as compared to laboratory testing 25 …”

Section: Discussionmentioning

confidence: 92%

“…Finally, the implementation of point-of-care molecular testing for SARS-CoV-2 RNA could deliver benefits to patient care admitted to hospital with COVID-19-related respiratory illness in terms of more rapid confirmation of coronavirus infection, a shorter length of stay, more rapid isolation practices of patients tested positive, and shorter turnaround time, as previously shown for influenza as compared to laboratory testing. 25 The limitations of our study include a relatively small sample size, inability to control for sampling variability, and lack of an additional comparator method to discern the discrepancies between VitaPCR™ and multiplex rRT-PCR results. Another possible limitation is the freezing of nasopharyngeal samples before their use with the VitaPCR™ platform.…”

Section: Discussionmentioning

confidence: 97%

Performances of the VitaPCR™ SARS‐CoV‐2 Assay during the second wave of the COVID‐19 epidemic in France

Fitoussi

Dupont

Tonen‐Wolyec

et al. 2021

Journal of Medical Virology

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To assess the practicability (usability and satisfaction) and analytical performances of the VitaPCR™ SARS-CoV-2 Assay (Credo Diagnostics Biomedical Pte. Ltd.), a rapid point-of-care nucleic acid amplification test (NAAT), by reference to real-time reverse-transcription polymerase chain reaction (rRT-PCR) for respiratory viruses. The practicability of the VitaPCR™ Assay and Instrument was assessed from usability evaluation and a satisfaction questionnaire. Nasopharyngeal swabs were collected from 239 patients with coronavirus disease 2019 (COVID-19)-like illness during the second epidemic wave, in Paris, France. Overall, the usability of the VitaPCR™ Instrument was high. The satisfaction questionnaire indicated a high appreciation of the VitaPCR™ NAAT mainly for the short duration of analysis in only 20 min. A total of 140 and 99 samples were positive and negative for SARS-CoV-2RNA by rRT-PCR, respectively. In the event of significant viral load (i.e., N gene C t values 33), the platform's analytical performances dropped significantly, with lower sensitivity, concordance, and accuracy, while its specificity remained high. The VitaPCR™ SARS-CoV-2 Assay is an accurate rapid point-of-care NAAT, suitable for clinical practice for the rapid diagnosis of COVID-19, especially in patients with COVID-19-suspected symptoms.

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“…COVID-19 patients may also be co-infected by other respiratory viruses, especially influenza, respiratory syncytial virus and adenovirus, which are the most common viral pathogens reported. However, the pathophysiology mechanism has not been well understood and data available from recent published studies are not enough to understand whether a viral co-infection affects the prognosis of COVID-19 patients [ 7 , 27 , 28 ]. Recently, Alosaimi et al in a study including 48 COVID-19 patients, reported that Influenza AH1N1 was the most common detected virus among the co-infecting pathogens, found in 64% of patients.…”

Section: Introductionmentioning

confidence: 99%

Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19

2021

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Introduction. It is known that bacterial infections represent a common complication during viral respiratory tract infections such as influenza, with a concomitant increase in morbidity and mortality. Nevertheless, the prevalence of bacterial co-infections and secondary infections in critically ill patients affected by coronavirus disease 2019 (COVID-19) is not well understood yet. We performed a review of the literature currently available to examine the incidence of bacterial secondary infections acquired during hospital stay and the risk factors associated with multidrug resistance. Most of the studies, mainly retrospective and single-centered, highlighted that the incidence of co-infections is low, affecting about 3.5% of hospitalized patients, while the majority are hospital acquired infections, developed later, generally 10–15 days after ICU admission. The prolonged ICU hospitalization and the extensive use of broad-spectrum antimicrobial drugs during the COVID-19 outbreak might have contributed to the selection of pathogens with different profiles of resistance. Consequently, the reported incidence of MDR bacterial infections in critically ill COVID-19 patients is high, ranging between 32% to 50%. MDR infections are linked to a higher length of stay in ICU but not to a higher risk of death. The only risk factor independently associated with MDR secondary infections reported was invasive mechanical ventilation (OR 1.062; 95% CI 1.012–1.114), but also steroid therapy and prolonged length of ICU stay may play a pivotal role. The empiric antimicrobial therapy for a ventilated patient with suspected or proven bacterial co-infection at ICU admission should be prescribed judiciously and managed according to a stewardship program in order to interrupt or adjust it on the basis of culture results.

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Point of care testing of Influenza A/B and RSV in an adult respiratory assessment unit is associated with improvement in isolation practices and reduction in hospital length of stay

Cited by 23 publications

References 25 publications

Added value of rapid respiratory syndromic testing at point of care versus central laboratory testing: a controlled clinical trial

Added value of rapid respiratory syndromic testing at point of care versus central laboratory testing: a controlled clinical trial

Performances of the VitaPCR™ SARS‐CoV‐2 Assay during the second wave of the COVID‐19 epidemic in France

Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19

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