Impact of point-of-care testing for respiratory viruses on antibiotic use in adults with exacerbation of airways disease.
Adult
Aged
Aged, 80 and over
Anti-Infective Agents
/ therapeutic use
Asthma
/ complications
Female
Humans
Influenza, Human
/ drug therapy
Male
Middle Aged
Picornaviridae Infections
/ drug therapy
Point-of-Care Systems
Point-of-Care Testing
Pulmonary Disease, Chronic Obstructive
/ complications
Rhinovirus
/ drug effects
Young Adult
Airways disease
Antibiotic use
Hospital
Point-of-care testing
Respiratory viruses
Syndromic
Journal
The Journal of infection
ISSN: 1532-2742
Titre abrégé: J Infect
Pays: England
ID NLM: 7908424
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
13
06
2019
accepted:
20
06
2019
pubmed:
25
6
2019
medline:
14
7
2020
entrez:
25
6
2019
Statut:
ppublish
Résumé
The ResPOC study demonstrated that syndromic molecular point-of-care testing (POCT) for respiratory viruses was associated with early discontinuation of unnecessary antibiotics compared to routine clinical care. Subgroup analysis suggests these changes occur predominantly in patients with exacerbation of airways disease. Use of molecular POCT for respiratory viruses is becoming widespread but there is a lack of evidence to inform the choice between multiplex syndromic panels versus POCT for influenza only. We evaluated patients from the ResPOC study with exacerbation of asthma or COPD who were treated with antibiotics. The duration of antibiotics and proportion with early discontinuation were compared between patients testing positive and negative for viruses by POCT, and controls. Patients testing positive for viruses by POCT were compared according to virus types. 118 patient with exacerbation of airways disease received antibiotics in the POCT group and 111 in the control group. In the POCT group 49/118 (42%) patients tested positive for viruses. Of those testing positive for viruses 17/49 (35%) had early discontinuation of antibiotics versus 9/69 (13%) testing negative and 7/111 (6%) of controls, p<0.0001. Of those positive for viruses by POCT 10/49 (20%) were positive for influenza, 21/49 (43%) for rhinovirus and 18/49 (37%) for other viruses. The proportion with early discontinuation of antibiotics was not different between the virus types (p = 0.34). This data suggests that syndromic molecular POCT for respiratory viruses should be favoured over POCT for influenza alone in adults with exacerbation of airways disease.
Sections du résumé
BACKGROUND
The ResPOC study demonstrated that syndromic molecular point-of-care testing (POCT) for respiratory viruses was associated with early discontinuation of unnecessary antibiotics compared to routine clinical care. Subgroup analysis suggests these changes occur predominantly in patients with exacerbation of airways disease. Use of molecular POCT for respiratory viruses is becoming widespread but there is a lack of evidence to inform the choice between multiplex syndromic panels versus POCT for influenza only.
MATERIALS/METHODS
We evaluated patients from the ResPOC study with exacerbation of asthma or COPD who were treated with antibiotics. The duration of antibiotics and proportion with early discontinuation were compared between patients testing positive and negative for viruses by POCT, and controls. Patients testing positive for viruses by POCT were compared according to virus types.
RESULTS
118 patient with exacerbation of airways disease received antibiotics in the POCT group and 111 in the control group. In the POCT group 49/118 (42%) patients tested positive for viruses. Of those testing positive for viruses 17/49 (35%) had early discontinuation of antibiotics versus 9/69 (13%) testing negative and 7/111 (6%) of controls, p<0.0001. Of those positive for viruses by POCT 10/49 (20%) were positive for influenza, 21/49 (43%) for rhinovirus and 18/49 (37%) for other viruses. The proportion with early discontinuation of antibiotics was not different between the virus types (p = 0.34).
CONCLUSIONS
This data suggests that syndromic molecular POCT for respiratory viruses should be favoured over POCT for influenza alone in adults with exacerbation of airways disease.
Identifiants
pubmed: 31233809
pii: S0163-4453(19)30191-4
doi: 10.1016/j.jinf.2019.06.010
pmc: PMC7112619
pii:
doi:
Substances chimiques
Anti-Infective Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
357-362Subventions
Organisme : Department of Health
ID : PDF-2016-09-061
Pays : United Kingdom
Informations de copyright
Copyright © 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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