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Point-of-care testing speeds diagnosis, cuts antibiotic use in LRTI

Pearl Toh
05 Jun 2019
Dr Duan Shengchen

Rapid identification of pathogens using a molecular point-of-care testing (POCT) significantly reduces intravenous antibiotic use and the duration of hospitalization among patients with acute lower respiratory tract infection (LRTI), a study presented at ATS 2019 shows.

Fast detection of LRTI-causing pathogens can guide early initiation of appropriate pathogen-directed therapy and is important for antimicrobial stewardship. “Many antibiotics were prescribed [unnecessarily] to patients with viral LRTI,” noted Dr Duan Shengchen of Xuanwu Hospital, Capital Medical University in Beijing, China.

The POCT in question is the FilmArray Respiratory Panel which tests for 17 viruses, 2 atypical pathogens, and 1 bacterium commonly associated with respiratory tract infections. The panel works on the FilmArray multiplex PCR system which requires only 2 minutes of hands-on time and generates results within an hour.  

In the single-centre, open-label study, 761 patients hospitalized for acute LRTI, such as pneumonia, or acute exacerbation of chronic obstructive pulmonary disease or bronchiectasis, were randomized 1:1 to POCT or routine care (control) whereby testing for specific pathogens was based on physician decision. [ATS 2019, abstract A4209/P401]

Virus and atypical pathogens were detected more frequently with POCT than with routine care (31.7 percent vs 8.5 percent; p<0.001).        

While the proportion of patients who received intravenous antibiotics were comparable between the two groups (92.2 percent vs 94.2 percent; p=0.27), early pathogen identification with POCT led to significantly shorter duration of antibiotic use compared with routine care (7 vs 8 days; p<0.001).  

POCT also allowed de-escalation of antibiotic therapy in more patients within the first 72 hours (7.0 percent vs 3.2 percent; p=0.015) as well as between 72 hours and 7 days (27.4 percent vs 21.4 percent; p=0.05) compared with those who underwent routine care.  

In addition, the length of hospitalization was significantly shorter by 1 day in the POCT group vs the control group (median, 8 vs 9 days; p<0.001). Cost of hospitalization was consequently reduced in the POCT group relative to the control group (US$1,761.1 vs $2,017.3; p<0.001).

“Use of POCT testing for respiratory viruses and atypical pathogens could help optimize antibiotic use and improve clinical outcomes in hospitalized LRTI patients … [while] improving utilization of other hospital resources,” said Duan.

The researchers also evaluated the utility of serum procalcitonin (PCT) testing in combination with POCT. High levels of PCT indicates severe bacterial infections which may be used to distinguish a bacterial infection from infections of other origins or inflammation.

Among patients in the POCT group, those who tested positive with PCT levels <0.25ng/mL had significantly reduced antibiotic use (median duration, 6 vs 7 days; p=0.0087) and hospitalization cost (US$1,374.6 vs $1939.6) than those who tested negative with PCT ≥0.25ng/mL.

Duan and colleagues also noted that turnaround time with the POCT was over 15 times faster than routine testing (median, 1.6 vs 27.5 hours; p<0.001).

 

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Most Read Articles
Roshini Claire Anthony, 11 Sep 2019

Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.

Elvira Manzano, 2 days ago

The US Preventive Services Task Force (USPSTF), in an update of its 2013 recommendations, called on clinicians to offer risk-reducing medications to women who are at increased risk for breast cancer but at low risk for adverse effects.

Pearl Toh, 3 days ago
The use of SGLT-2* inhibitors was not associated with a higher risk of severe or nonsevere urinary tract infections (UTIs) in patients with type 2 diabetes (T2D) compared with DPP**-4 inhibitors or GLP-1*** receptor agonists, a population-based cohort study shows.
14 Sep 2019
In type 2 diabetes patients taking sulfonylureas, hypoglycaemia duration is longer at night and is inversely correlated with the level of glycated haemoglobin (HbA1c), a new study reports.