Publication: 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
Issued Date
2017
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Infectious Diseases. Vol.17, (2017), 671
Suggested Citation
Andrews, Denise, Chetty, Yumela, Cooper, Ben S., Virk, Manjinder, Glass, Stephen K, Letters, Andrew, Kelly, Philip A., Sudhanva, Malur, Jeyaratnam, Dakshika 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. BMC Infectious Diseases. Vol.17, (2017), 671. doi:10.1186/s12879-017-2784-z Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/2856
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Title
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
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Abstract
Background: 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.
Methods: 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).
Results: 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 < 0.
001. Only the prescribing decision differed between study arms, p < 0.001. When antivirals were given, the
intervention was associated with a reduction in the median time to the first dose of 36 h and allowed appropriate
treatment of mycoplasma infection.Conclusions: We found no association between respiratory PCR POC testing and length of stay or most of the secondary
outcomes except the antimicrobial prescribing decision. This was probably due to a delay in initiating FilmArray® testing.
Despite this, POC testing allowed time-critical antivirals to be given significantly faster, appropriate mycoplasma treatment
and results were available considerably faster than routine, laboratory-based testing. Ward-staff of all grades performed
POC testing without difficulty suggesting potential use across many divergent healthcare settings. Further studies
evaluating the implementation of rapid respiratory PCR POC testing and the effect on length of stay and antimicrobial
use are required.
Trial registration: ISRCTN10470967, Retrospectively Registered, 30/6/2015.