Viral respiratory infection POCT could reduce unnecessary hospitalization, antibiotics
The implementation of point-of-care testing (POCT) for viral respiratory infections in emergency departments could reduce unnecessary hospitalizations and antibiotic treatment, according to a study from the UK.
The study included 901 individuals who presented at the emergency department or acute admissions unit of Watford General Hospital, Hertfordshire, UK, between 15th January (when POCT was launched in the hospital) and 1st May 2018 with symptoms of suspected viral respiratory infection and who underwent POCT. Participants provided nasopharyngeal swabs – results of which could be available within 45 minutes through POCT – and underwent chest radiography. Of these, 507 individuals tested positive for a viral infection, the most common of which was influenza. [ERS 2018, abstract PA2032]
A total of 239 patients had a positive POCT result, C-reactive protein <50, and a normal chest x-ray, while 72 patients had a positive POCT result, but C-reactive protein ≥50, and abnormal chest x-ray findings.
Eighty-five patients with positive POCT, C-reactive protein <50, and a normal chest x-ray were discharged from the emergency department.
Upon receipt of POCT results, antibiotic treatment was ceased in 52 percent of patients with normal chest x-ray findings and C-reactive protein <50, with antibiotic treatment continued in 90 percent of patients with abnormal C-reactive protein levels and chest x-ray findings.
“The whole process from obtaining a sample from the patient’s nose to getting a result should take under 50 minutes, which has a potentially enormous impact on quality of care, improving the patient journey by allowing earlier, informed decision-making about patient management,” said study author Dr Kay Roy, a consultant in respiratory and general internal medicine at West Hertfordshire Hospitals NHS Trust, Watford, UK, who pointed out that testing at microbiology laboratories could take more than 2 days to produce results.
“We found that when patients had point of care respiratory viral testing soon after they were admitted to the emergency department, bed flow improved and fewer bed closures were required due to viral infections. This is extremely valuable during winter bed pressures, especially during an influenza epidemic,” said Roy.
“In the first 2 weeks of this new service, we diagnosed 50 cases of influenza, 22 by testing in the emergency department and 28 after patients were admitted. There were no bed moves in the former group but 14 in the latter, demonstrating that earlier bedside testing in the emergency department improves infection control, thereby avoiding bed and ward closures and reducing the risk of spreading infection to vulnerable groups. Infected patients with POCT-based early diagnosis of influenza can be admitted to appropriately designated beds if admission is required,” she said.
“The frequent underestimation of the role of viruses in respiratory admissions, both in previously well patients and those with chronic underlying disease such as chronic obstructive pulmonary disease, has hindered good antimicrobial stewardship,” said Roy. “This has sometimes led to other health problems for patients from inappropriate antibiotic use and hospital admission. We hope that quality of patient care can be improved with POCT for respiratory viruses, as well as helping to reduce the development of antibiotic resistance,” she said.
However, according to Professor Tobias Welte, ERS President-Elect who was not involved in the study, POCT, while having the potential to improve patient quality of life by reducing antibiotic use and hospitalization, will still require comparison with practice guidelines to assess its usefulness in clinical practice.