Routine molecular point-of-care testing improves flu detection in hospitalized patients
Routine use of a molecular point-of-care test-and-treat strategy for influenza improved detection and other outcomes in patients admitted to the hospital, according to results of the FluPOC trial.
“Molecular point-of-care [testing] for influenza in acute admissions allows confident real-time decision making,” Tristan W. Clark, MD, associate professor and honorary consultant in infectious diseases at the University of Southampton School of Clinical and Experimental Sciences, U.K., told Healio. “This is associated with a wide range of benefits compared to lab testing, where clinical decisions have to be made based on clinical assessment, which is inaccurate, and then adapted when results come back many hours later.”
The multicenter, pragmatic, open-label, randomized, controlled FluPOC trial included 613 adults (median age, 62 years; 54% women) admitted to the hospital with an acute respiratory illness during influenza seasons from December 2017 to May 2019 in Hampshire, U.K. All patients had acute respiratory illness of 10 days or fewer duration before hospital admission and were recruited within 16 hours of hospital admission.
Patients were randomly assigned to undergo molecular point-of-care testing for influenza (n = 307) or routine clinical care (n = 306). The molecular point-of-care testing group had nose and throat swabs, and sputum samples when available, analyzed immediately using the FilmArray Respiratory Panel 2 (BioFire Diagnostics). The routine clinical care control group had testing performed at the discretion of the clinical team; any testing done was by laboratory polymerase chain reaction.
The primary outcome was the proportion of patients with influenza treated appropriately with antivirals within 5 days of admission. The secondary outcomes included time to antiviral use, isolation facility use and clinical outcomes.
In the molecular point-of-care testing group, 33% had influenza compared with 33% of the control group. All patients with influenza in the molecular point-of-care testing group were diagnosed, whereas 59% of the control group was diagnosed through routine clinical care (RR = 1.7; 95% CI, 1.7-1.7; P < .0001).
Neuraminidase inhibitors were administered within 5 days of admission in 99% of patients with influenza in the molecular point-of-care testing group compared with 62% of the control group (RR = 1.6; 95% CI, 1.4-1.9; P < .0001). The median time to antiviral treatment was 1 hour in the molecular point-of-care testing group compared with 6 hours in the control group (P = .0039).
Isolation to single-room accommodation occurred in 70% of patients with influenza in the molecular point-of-care testing group compared with 38% of the control group (RR = 1.8; 95% CI, 1.4-2.4; P < .0001).
Nineteen adverse events occurred in the molecular point-of-care testing group compared with 34 adverse events in the control group. Two deaths occurred in the control group and none in the molecular point-of-care testing group (P = .16).
Clark said implementation research is needed to define the best deployment model for molecular point-of-care testing for influenza, such as determining which platform is best for which clinical case, where the testing units should be sited, who should perform the tests, whether tests should detect all respiratory viruses or whether testing for more detrimental viruses is enough and cost-effectiveness.
“These findings of our study are also directly applicable to COVID-19 where the need for rapid accurate results is recognized to identify cases coming into hospital and prevent nosocomial transmission, which was a big problem in the U.K. during the first wave and associated with a very high mortality,” Clark said.
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Tristan W. Clark, MD, can be reached at t.w.clark@soton.ac.uk.