Molecular point-of-care testing shortens hospital stay for respiratory viruses

Rapid point-of-care testing for respiratory viruses was associated with a shorter hospital stay, shorter courses of antibiotics and improved influenza detection among patients who were hospitalized with respiratory illnesses, according to researchers in the United Kingdom.

“Lung infections in asthma and COPD patients are a common cause of antibiotic overuse,” Tristan Clark, MD, associate professor of infectious diseases at the University of Southampton, said in a press release accompanying the study. “Antibiotics are only effective at treating bacterial infections and not infections caused by a virus like the cold or flu viruses, yet they are often given antibiotics ‘just in case,’ when the cause of the infection is not immediately apparent.”

The researchers performed a parallel-group, open-label, randomized controlled trial of adults who were in the ED or ICU of a large hospital between either Jan. 15, 2015 and April 30, 2015, or Oct. 1, 2015 and April 30, 2016. All patients had either acute respiratory illnesses or a fever (temperature higher than 37.5°C. The patients were randomly assigned to a molecular point-of-care test for respiratory viruses (n = 362) or to receive routine clinical care (n = 358). The main outcome was the proportion of patients who were treated with antibiotics during their hospital stay. Secondary outcomes were duration of antibiotics, proportion of patients receiving either single doses or short courses of antibiotics, antiviral use, isolation facility use, length of stay and safety.

Six patients withdrew consent or had protocol violations. Of the remaining patients, 84% of those in the point-of-care testing group received antibiotics, compared with 83% of controls, the researchers reported. There was no significant difference in mean duration of antibiotics between groups (7.2 days in point-of-care group vs. 7.7 days in control group; difference, –0.4; 95% CI, –1.2 to 0.4).

Of 301 patients who were treated with antibiotics in the point-of-care group, 50 (17%) received single doses or short courses of treatment, compared with 26 (9%) of controls (difference, 7.8%; 95% CI, 2.5-13.1), Clark and colleagues wrote. Patients in the point-of-care testing group had a shorter mean length of stay (5.7 days vs. 6.8 days; difference, –1.1; 95% CI, –2.2 to –0.3). The researchers reported that influenza-positive patients in the point-of-care group received appropriate antiviral treatment more often than those in the control group (91%, n = 52 of 57 vs. 65%, n = 24 of 37; difference, 26.4%; 95% CI, 9.6-43.2). Clark and colleagues reported no significant differences in adverse outcomes between groups (21% in point-of-care test group vs 25% of controls; difference, –3.5%; 95% CI, –9.7 to 2.7).

“My vision is that anyone who comes into hospital with an acute respiratory condition will receive this point-of-care test as soon as they come through the hospital door,” Clark said in the press release. “It tells us immediately what virus the person has so, for example, if they have the flu they can be isolated in a side room and given antiviral drugs without delay. Tests like this, which enable tailored and personalized medicine, have a major role to play in the fight against antibiotic resistance.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.