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