Rapid Multiplex Testing for Upper Respiratory Pathogens in the Emergency Department: A Randomized Controlled Trial

Abstract

Background. Acute upper respiratory tract infections are a common cause of emergency department (ED) visits and often result in unnecessary antibiotic treatment.Methods. We conducted a randomized clinical trial to evaluate the impact of a rapid, multipathogen respiratory panel (RP) test vs usual care (control). Patients were eligible if they were ≥12 months old, had symptoms of upper respiratory infection or influenzalike illness, and were not on antibiotics. The primary outcome was antibiotic prescription; secondary outcomes included antiviral prescription, disposition, and length of stay (ClinicalTrials.gov# NCT02957136).Results. Of 191 patients enrolled, 93 (49%) received RP testing; 98 (51%) received usual care. Fifty-three (57%) RP and 7 (7%) control patients had a virus detected and reported during the ED visit (P = .0001). Twenty (22%) RP patients and 33 (34%) usual care patients received antibiotics during the ED visit (-12%; 95% confidence interval, -25% to 0.4%; P = .06/0.08); 9 RP patients received antibiotics despite having a virus detected. The magnitude of antibiotic reduction was greater in children (-19%) vs adults (-9%, post hoc analysis). There was no difference in antiviral use, length of stay, or disposition.Conclusions. Rapid RP testing was associated with a trend toward decreased antibiotic use, suggesting a potential benefit from more rapid viral tests in the ED. Future studies should determine if specific groups are more likely to benefit from testing and evaluate the relative cost and effectiveness of broad testing, focused testing, and a combined diagnostic and antimicrobial stewardship approach.

Utility of the respiratory viral panel as an antimicrobial stewardship tool

“…While the RVP numerically reduced antimicrobial prescribing (22% vs 34%, p = 0.06), this result did not reach statistical significance. However, the authors were unable to enrol the necessary 304 patients required to achieve 80% power, and, as such, type II error may be present in this study 8 …”

Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review

“…When evaluating the efficacy of ASPs, the most commonly used measures included proportion of appropriate first-line antibiotic use and broad-spectrum antibiotics. The effects of overall antibiotic use were well reported by the included studies, and the postintervention difference was statistically significant in nine of thirteen studies [13,24,26,27,29,30,[33][34][35]. As effects were seen in a variety of ASP multimodal intervention types, it can be difficult to ascertain which strategies optimised ASP delivery and therefore efficacy.…”

Severe influenza/respiratory syncytial virus infections and hospital antimicrobial stewardship opportunities: impact of a 4-year surveillance including molecular diagnosis

“…15 Recent studies assessing the impact of a viral diagnosis on antimicrobial management in hospitalized adults remain inconclusive or present a wide range of designs with mixed results. [16][17][18][19][20][21][22][23][24][25] Furthermore, influenza and RSV illness severity patterns are not necessarily associated with bacterial coinfections (eg, in older patients and/or patients with comorbidities). A positive viral diagnosis can therefore help clinicians to decide whether to withhold or discontinue antibiotic treatment based on patient medical history, clinical presentation, and available bacterial investigations results.…”