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Impact of point-of-care testing for respiratory viruses on antibiotic use in adults with exacerbation of airways disease

Impact of point-of-care testing for respiratory viruses on antibiotic use in adults with exacerbation of airways disease
Impact of point-of-care testing for respiratory viruses on antibiotic use in adults with exacerbation of airways disease
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 suggested that syndromic molecular POCT for respiratory viruses should be favoured over POCT for influenza alone in adults with exacerbation of airways disease.International Standard Randomised Controlled Trial Number (ISRCTN): 90211642
0163-4453
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
Brendish, Nathan, James
d07b588f-4919-456d-8604-04efde7711fd
Mills, Samuel
bf3525fe-f39a-4896-8ee3-5b60ad704b6f
Ewings, Sean
326656df-c0f0-44a1-b64f-8fe9578ca18a
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
Brendish, Nathan, James
d07b588f-4919-456d-8604-04efde7711fd
Mills, Samuel
bf3525fe-f39a-4896-8ee3-5b60ad704b6f
Ewings, Sean
326656df-c0f0-44a1-b64f-8fe9578ca18a

Clark, Tristan, Brendish, Nathan, James, Mills, Samuel and Ewings, Sean (2019) Impact of point-of-care testing for respiratory viruses on antibiotic use in adults with exacerbation of airways disease. Journal of Infection. (doi:10.1016/j.jinf.2019.06.010).

Record type: Article

Abstract

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 suggested that syndromic molecular POCT for respiratory viruses should be favoured over POCT for influenza alone in adults with exacerbation of airways disease.International Standard Randomised Controlled Trial Number (ISRCTN): 90211642

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Accepted/In Press date: 20 June 2019
e-pub ahead of print date: 21 June 2019

Identifiers

Local EPrints ID: 432444
URI: https://eprints.soton.ac.uk/id/eprint/432444
ISSN: 0163-4453
PURE UUID: 8bd7ffd9-9010-44f7-ac1b-a1c80c9acfca
ORCID for Tristan Clark: ORCID iD orcid.org/0000-0001-6026-5295
ORCID for Nathan, James Brendish: ORCID iD orcid.org/0000-0002-9589-4937
ORCID for Sean Ewings: ORCID iD orcid.org/0000-0001-7214-4917

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Date deposited: 15 Jul 2019 16:30
Last modified: 03 Sep 2019 00:34

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