Multiplex PCR point of care testing versus routine, laboratory-based testing in the treatment of adults with respiratory tract infections: a quasi-randomised study assessing impact on length of stay and antimicrobial use

• Published in: BMC infectious diseases 2017-10, Vol.17 (1), p.671-671, Article 671
• Main Authors: Andrews, Denise, Chetty, Yumela, Cooper, Ben S, Virk, Manjinder, Glass, Stephen K, Letters, Andrew, Kelly, Philip A, Sudhanva, Malur, Jeyaratnam, Dakshika
• Format: Article
• Language: English
• Subjects: Adults; Aged; Anti-Infective Agents - therapeutic use; Antibiotics; Antimicrobial agents; Bacterial infections; Chlamydia; Chlamydia pneumoniae; Clinical outcomes; Emergency medical care; Epidemics; Female; FilmArray; Holidays & special occasions; Hospital costs; Hospitalization; Humans; Illnesses; Infections; Infectious diseases; Influenza; Influenza, Human - genetics; Length of stay; Length of Stay - statistics & numerical data; Male; Middle Aged; Multiplex Polymerase Chain Reaction - methods; Multiplexing; Mycoplasma pneumoniae; Patients; Pneumonia; Point of care; Point-of-Care Testing - statistics & numerical data; Point-of-Care Testing - utilization; Respiratory pathogens; Respiratory syncytial virus; Respiratory tract; Respiratory tract diseases; Respiratory tract infection; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - microbiology; Respiratory viruses; Retrospective Studies; Testing laboratories; Viruses
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-017-2784-z

Laboratory-based respiratory pathogen (RP) results are often available too late to influence clinical decisions such as hospitalisation or antibiotic treatment due to time delay in transport of specimens and testing schedules. Ward-based i.e. point of care (POC) testing providing rapid results may alter the clinical management pathway. FilmArray® RP polymerase chain reaction (PCR) systems were placed in three in-patient and out-patient medical areas. Patients presenting with influenza-like illness /upper respiratory tract infection +/- lower RTI were recruited between January-July 2015. FilmArray® POC testing occurred on even days of the month (intervention) or routine, laboratory-based RP PCR testing +/- atypical serology on odd days (control). The primary outcome was length of hospital stay. The secondary outcomes were impact on the use of antimicrobials, readmissions, all-cause mortality, length of ward stay and turn-around time (TAT) (time to result from admission). Of 606 eligible patients, 545 (89.9%) were included; 211 in the control arm and 334 in the intervention arm. 20% of control arm patients and 24% of intervention arm patients had an RP detected. POC testing was not associated with the primary outcome measure, length of stay, but reduced the TAT from 39.5 h to 19.0 h, p