Rapid influenza tests may reduce antibiotic prescriptions, improve patient outcomes
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Using rapid influenza diagnostic tests for patients presenting with acute respiratory infections may lead clinicians to prescribe fewer unnecessary antibiotics, which could improve patient outcomes and decrease the threat of resistance, researchers found.
“At the start of 2021, I was headed into the final year of my MPH degree and in need of a topic for my practicum and capstone project. I was hesitant to focus on COVID-19 because the research was changing so rapidly, and I needed a topic that I could rely on being stable while I performed my research,” Brian D. Stamm, MBA, MPH, honorary associate in the University of Wisconsin School of Medicine and Public Health’s department of family medicine and community health, told Healio.
“I reached out to Jonathan Temte, MD, PhD, who I'd worked with on a COVID-19 workgroup, to see if he had any ideas, and it just so happens that he had a wonderful project that had to be shelved when COVID-19 began,” Stamm said.
According to Stamm, Temte and his research team had collected data from more than 1,000 participants at local urgent care facilities attempting to quantify the ability for patients to self-collect specimens using a rapid influenza diagnostic test (RIDT).
This led Stamm and the research team to want to gather insight into the differences in clinical decision-making of clinicians when treating a patient presenting with acute respiratory infection (ARI) symptoms in an urgent care setting in the presence and absence of a RIDT.
He said that there have been a few studies similar to this in the past and with the mass utilization of at-home rapid COVID-19 tests, “it seemed like the culture of the health care community would be open to new information about a practical application of RIDTs.”
For the study, Stamm and colleagues compared patients with ARI symptoms who received an RIDT to patients who did not at two urgent care facilities. The primary analysis compared participants who had an RIDT used during their clinical encounter with participants who did not have an RIDT used and assessed antibiotic and antiviral prescribing behaviors.
Stamm said the results surprised the research team.
Overall, they found that patients who tested positive with an RIDT were more likely to be prescribed antivirals (OR = 10.23; 95% CI, 5.78-19.72) and less likely to be prescribed antibiotics (OR = 0.15; 95% CI, 0.08-0.27), compared with those without an RIDT. When comparing all RIDT-tested participants to all non-RIDT-tested participants, RIDT use increased antiviral prescribing odds (OR = 3.07; 95% CI, 2.25-4.26) but reduced antibiotic prescribing odds (OR = 0.52; 95% CI:0.43-0.63).
Stamm said these results were “pretty shocking,” equating to an 85% reduction in the odds of prescribing an antibiotic to participants who tested positive with an RIDT, a 30% reduction in those that tested negative and a 48% reduction to the whole population, while increasing the odds of antiviral prescribing by 923% among participants who tested positive with the RIDT.
“We believe that the mere presence of the RIDT may have altered diagnostic and treatment behavior by putting the clinician in the frame of mind that the patient's symptoms could be caused by a viral pathogen rather than a bacterial infection,” Stamm said.
In a secondary analysis comparing the same outcomes using logistic regression among the RIDT-tested population between participants who tested negative and positive, they found an 80% decrease in the odds of ordering antibiotics (OR = 0.2; 95% CI, 0.13-0.30) and a 2,821% increase in the odds of prescribing antivirals (OR = 28.21; 95% CI,18.15-43.86) for participants who tested positive using the RIDT compared with those who tested negative.
Stamm said these results demonstrate significant differences in clinical decision-making when RIDTs are used during clinical encounters with patients presenting with ARI symptoms compared to when RIDTs are not available.
“If you have a patient presenting with ARI symptoms, then why would you not use a quick, easy tool to help in your diagnosis,” he said, explaining further that, often times, clinicians are “pressured by patients for antibiotics” regardless of appropriateness, and that an RIDT can be used to help a patient come to the realization that an antibiotic is not needed if the clinician guides the conversation in conjunction with the use of an RIDT.
“Fewer inappropriate antibiotic prescriptions today will directly impact the future burden of antibiotic resistance,” Stamm said. “Most importantly, if influenza is identified through the use of an RIDT, then the clinician can prescribe antivirals to treat the disease in a timely fashion, which will help the patient feel better sooner and hopefully reduce the population burden of influenza.”
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