The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients

Wabe, Nasir

doi:10.5694/mja2.50442

Cited by 9 publications

(16 citation statements)

References 4 publications

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“…The IDSA guidelines recommend molecular influenza assays for testing respiratory specimens from all hospitalized patients with suspected influenza because of their high sensitivity, specificity, and time to results (15 min to several hours) [49]. The use of rapid influenza molecular diagnostic testing can result in better outcomes for patients and reduce the amount of resources required to care for patients in the emergency room [57]. Serology and viral culture are not recommended for clinical decision making, because timely results will not be available to inform clinical management.…”

Section: Diagnosismentioning

confidence: 99%

Influenza virus-related critical illness: prevention, diagnosis, treatment

2019

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Annual seasonal influenza epidemics of variable severity result in significant morbidity and mortality in the United States (U.S.) and worldwide. In temperate climate countries, including the U.S., influenza activity peaks during the winter months. Annual influenza vaccination is recommended for all persons in the U.S. aged 6 months and older, and among those at increased risk for influenza-related complications in other parts of the world (e.g. young children, elderly). Observational studies have reported effectiveness of influenza vaccination to reduce the risks of severe disease requiring hospitalization, intensive care unit admission, and death. A diagnosis of influenza should be considered in critically ill patients admitted with complications such as exacerbation of underlying chronic comorbidities, community-acquired pneumonia, and respiratory failure during influenza season. Molecular tests are recommended for influenza testing of respiratory specimens in hospitalized patients. Antigen detection assays are not recommended in critically ill patients because of lower sensitivity; negative results of these tests should not be used to make clinical decisions, and respiratory specimens should be tested for influenza by molecular assays. Because critically ill patients with lower respiratory tract disease may have cleared influenza virus in the upper respiratory tract, but have prolonged influenza viral replication in the lower respiratory tract, an endotracheal aspirate (preferentially) or bronchoalveolar lavage fluid specimen (if collected for other diagnostic purposes) should be tested by molecular assay for detection of influenza viruses. Observational studies have reported that antiviral treatment of critically ill adult influenza patients with a neuraminidase inhibitor is associated with survival benefit. Since earlier initiation of antiviral treatment is associated with the greatest clinical benefit, standard-dose oseltamivir (75 mg twice daily in adults) for enteric administration is recommended as soon as possible as it is well absorbed in critically ill patients. Based upon observational data that suggest harms, adjunctive corticosteroid treatment is currently not recommended for children or adults hospitalized with influenza, including critically ill patients, unless clinically indicated for another reason, such as treatment of asthma or COPD exacerbation, or septic shock. A number of pharmaceutical agents are in development for treatment of severe influenza.

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Section: Diagnosismentioning

confidence: 99%

Influenza virus-related critical illness: prevention, diagnosis, treatment

2019

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“…There have been a small number of studies published on RPCR testing and its impact on LOS both in ED and inpatient settings. [34,[37][38][39] Overall, these studies have been of varying design and have demonstrated different outcomes. Factors identi ed that affected LOS included being provided positive RPCR results during hospital stay or delays in timing of patient diagnostic sampling.…”

Section: Discussionmentioning

confidence: 99%

Differences in Antibiotic and Antiviral Use in People With Confirmed Influenza: a Retrospective Comparison of Rapid Influenza PCR and Multiplex Respiratory Virus PCR Tests.

Yeung¹,

Thapa²,

Rawlinson

et al. 2020

Preprint

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BACKGROUND Influenza is a highly contagious respiratory virus with clinical impacts on patient morbidity, mortality and hospital bed management. The effect of rapid nucleic acid testing (RPCR) in comparison to standard multiplex PCR (MPCR) diagnosis in treatment decisions is unclear. This study aimed to determine whether RPCR influenza testing in comparison to standard MPCR testing was associated with differences in antibiotic and antiviral (oseltamivir) utilisation and hospital length of stay in emergency department and inpatient hospital settings. METHODS A retrospective cohort study of positive influenza RPCR and MPCR patients was performed utilising data from the 2017 influenza season. Medical records of correlating patient presentations were reviewed for data collection. An analysis of RPCR versus MPCR patient outcomes was performed examining test turnaround time, antibiotic initiation, oseltamivir initiation and hospital length of stay for both emergency department and inpatient hospital stay. Subgroup analysis was performed to assess oseltamivir use in high risk populations for influenza complications. Statistical significance was assessed using Mann-Whitney test for numerical data and Chi-squared test for categorical data. Odds ratio with 95% confidence intervals were calculated where appropriate.RESULTS Overall, 122 RPCR and 362 MPCR positive influenza patients were included in this study. Commencement of antibiotics was less frequent in the RPCR than MPCR cohorts (51% vs 67%; p <0.01, OR 0.52; 95% CI 0.34-0.79). People at high risk of complications from influenza who were tested with the RPCR were more likely to be treated with oseltamivir compared to those tested with the MPCR (76% vs 63%; p = 0.03, OR 1.81; 95% CI 1.07-3.08). Hospital length of stay was not impacted when either test was used in the emergency department and inpatient settings. CONCLUSIONS These findings suggest utilisation of RPCR testing in influenza management can improve antibiotic stewardship through reduction in antibiotic use and improvement in oseltamivir initiation in those at higher risk of complications. Further research is required to determine other factors that may have influenced hospital length of stay and a cost-benefit analysis should be undertaken to determine the financial impact of the RPCR test.

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“…Detailed information regarding the use of the two assays has been reported in our previous studies 8,10,21 . Briefly, Allplex ™ RP has been used as a referral test at a large central laboratory located at Hospital B and all other hospitals sent samples to this laboratory for analysis.…”

Section: Methodsmentioning

confidence: 99%

“…The Xpert Flu/RSV XC is an automated, multiplex real‐time, RT‐PCR assay for the detection of influenza A, influenza B, and RSV 9 . It has a faster turnaround time of 1‐4 hours, 8,10 but unlike the Allplex ™ RP1, Xpert ® Flu/RSV cannot discriminate among influenza A virus subtypes. Nevertheless, the rapid identification of respiratory viruses has the potential to improve patient outcomes by supporting clinical decision‐making around antimicrobial use 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the rapid identification of respiratory viruses has the potential to improve patient outcomes by supporting clinical decision‐making around antimicrobial use 11 . More rapid identification could also improve clinical processes, including optimizing bed management and infection control 12 as well as minimizing unnecessary ancillary test utilizations, 8,10,13 with subsequent reductions to healthcare costs 14 …”

Section: Introductionmentioning

confidence: 99%

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Cepheid Xpert^® Flu/RSV and Seegene Allplex^™ RP1 show high diagnostic agreement for the detection of influenza A/B and respiratory syncytial viruses in clinical practice

Wabe

Lindeman

Post

et al. 2020

Influenza Resp Viruses

Self Cite

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Background Molecular assays based on reverse transcription‐polymerase chain reaction (RT‐PCR) provide reliable results for the detection of respiratory pathogens, although diagnostic agreement varies. This study determined the agreement between the RT‐PCR assays (Xpert ® Flu/RSV vs Allplex ™ RP1) in detecting influenza A, influenza B, and respiratory syncytial viruses (RSVs) in clinical practice. Methods We retrospectively identified 914 patient encounters where testing with both Xpert ® Flu/RSV and Allplex ™ RP1 was undertaken between October 2015 and September 2019 in seven hospitals across New South Wales, Australia. The diagnostic agreement of the two assays was evaluated using positive percent agreement, negative percent agreement, and prevalence and bias‐adjusted kappa. Results The positive percent agreement was 95.1% for influenza A, 87.5% for influenza B, and 77.8% for RSV. The negative percent agreement was 99.4% for influenza A, 99.9% for influenza B, and 100% for RSV. The prevalence and bias‐adjusted kappa was 0.98 for influenza A, 0.99 for influenza B, and 0.97 for RSV. In a sensitivity analysis, the positive percent agreement values were significantly higher during the non‐influenza season than the influenza season for influenza B and RSV. Conclusions The Xpert ® Flu/RSV and Allplex ™ RP1 demonstrated a high diagnostic agreement for all three viruses assessed. The seasonal variation in the positive percent agreement of the two assays for influenza B and RSV may have been due to lower numbers assessed, variability in the virology of infections outside the peak season, or changes in the physiology of the infected host in different seasons.

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The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients

Cited by 9 publications

References 4 publications

Influenza virus-related critical illness: prevention, diagnosis, treatment

Influenza virus-related critical illness: prevention, diagnosis, treatment

Differences in Antibiotic and Antiviral Use in People With Confirmed Influenza: a Retrospective Comparison of Rapid Influenza PCR and Multiplex Respiratory Virus PCR Tests.

Cepheid Xpert^® Flu/RSV and Seegene Allplex^™ RP1 show high diagnostic agreement for the detection of influenza A/B and respiratory syncytial viruses in clinical practice

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The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients

Cited by 9 publications

References 4 publications

Influenza virus-related critical illness: prevention, diagnosis, treatment

Influenza virus-related critical illness: prevention, diagnosis, treatment

Differences in Antibiotic and Antiviral Use in People With Confirmed Influenza: a Retrospective Comparison of Rapid Influenza&nbsp;PCR and Multiplex Respiratory Virus PCR Tests.

Cepheid Xpert® Flu/RSV and Seegene Allplex™ RP1 show high diagnostic agreement for the detection of influenza A/B and respiratory syncytial viruses in clinical practice

Contact Info

Product

Resources

About

Differences in Antibiotic and Antiviral Use in People With Confirmed Influenza: a Retrospective Comparison of Rapid Influenza PCR and Multiplex Respiratory Virus PCR Tests.

Cepheid Xpert^® Flu/RSV and Seegene Allplex^™ RP1 show high diagnostic agreement for the detection of influenza A/B and respiratory syncytial viruses in clinical practice