Systematic Review of the Impact of Point-of-care Testing for Influenza on the Outcomes of Patients with Acute Respiratory Tract Infection

Overview

Journal Rev Med Virol

Publisher Wiley

Specialty Microbiology

Date 2018 Aug 14

PMID 30101552

Citations 35

Authors

Ece Egilmezer

Gregory J Walker

Padmavathy Bakthavathsalam

Joshua R Peterson

J Justin Gooding

William Rawlinson

Sacha Stelzer-Braid

Affiliations

Soon will be listed here.

Abstract

Acute respiratory tract infections are a major cause of morbidity and mortality and represent a significant burden on the health care system. Laboratory testing is required to definitively distinguish infecting influenza virus from other pathogens, resulting in prolonged emergency department (ED) visits and unnecessary antibiotic use. Recently available rapid point-of-care tests (POCT) may allow for appropriate use of antiviral and antibiotic treatments and decrease patient lengths of stay. We undertook a systematic review to assess the effect of POCT for influenza on three outcomes: (1) antiviral prescription, (2) antibiotic prescription, and (3) patient length of stay in the ED. The databases Medline and Embase were searched using MeSH terms and keywords for influenza, POCT, antivirals, antibiotics, and length of stay. Amongst 245 studies screened, 30 were included. The majority of papers reporting on antiviral prescription found that a positive POCT result significantly increased use of antivirals for influenza compared with negative POCT results and standard supportive care. A positive POCT result also led to decreased antibiotic use. The results of studies assessing the effect of POCT on ED length of stay were not definitive. The studies assessed in this systematic review support the use of POCT for diagnosis of influenza in patients suffering an acute respiratory infection. Diagnosis using POCT may lead to more appropriate prescription of treatments for infectious agents. Further studies are needed to assess the effect of POCT on the length of stay in ED.

Citing Articles

The Impact of Rapid Molecular Diagnostics for Influenza on Antibiotic Stewardship in the Emergency Department-An Observational Retrospective Study.

Roth E, Cattaneo M, Hollenstein Y, Weisser M, Bassetti S, Tschudin Sutter S Antibiotics (Basel). 2025; 14(2).

PMID: 40001364 PMC: 11851583. DOI: 10.3390/antibiotics14020120.

Clinical impact of rapid molecular diagnostic tests in patients presenting with viral respiratory symptoms: A systematic literature review.

Mojebi A, Wu P, Keeping S, Hale B, Chase J, Beaubrun A PLoS One. 2024; 19(6):e0303560.

PMID: 38870136 PMC: 11175541. DOI: 10.1371/journal.pone.0303560.

The Role and Value of Professional Rapid Testing of Acute Respiratory Infections (ARIs) in Europe: A Special Focus on the Czech Republic, Poland, and Romania.

Drevinek P, Flisiak R, Nemes R, Nogales Crespo K, Tomasiewicz K Diagnostics (Basel). 2024; 14(6).

PMID: 38535051 PMC: 10969707. DOI: 10.3390/diagnostics14060631.

Accurate detection of influenza A virus by use of a novel cross-priming isothermal amplification-based point-of-care assay.

Deng J, Zhu H, An S, Huang H, Wang R, Chen Y Microbiol Spectr. 2024; 12(3):e0307423.

PMID: 38349165 PMC: 10913471. DOI: 10.1128/spectrum.03074-23.

ECHOPvir: A Mixture of Echinacea and Hop Extracts Endowed with Cytoprotective, Immunomodulatory and Antiviral Properties.

Percaccio E, De Angelis M, Acquaviva A, Nicotra G, Ferrante C, Mazzanti G Nutrients. 2023; 15(20).

PMID: 37892456 PMC: 10609862. DOI: 10.3390/nu15204380.

References

McCullough A, Pollack A, Hansen M, Glasziou P, Looke D, Britt H . Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations. Med J Aust. 2017; 207(2):65-69. DOI: 10.5694/mja16.01042. View

Brendish N, Malachira A, Armstrong L, Houghton R, Aitken S, Nyimbili E . Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial. Lancet Respir Med. 2017; 5(5):401-411. PMC: 7164815. DOI: 10.1016/S2213-2600(17)30120-0. View

Iyer S, Gerber M, Pomerantz W, Mortensen J, Ruddy R . Effect of point-of-care influenza testing on management of febrile children. Acad Emerg Med. 2006; 13(12):1259-68. DOI: 10.1197/j.aem.2006.07.026. View

Popowitch E, Miller M . Performance Characteristics of Xpert Flu/RSV XC Assay. J Clin Microbiol. 2015; 53(8):2720-1. PMC: 4508419. DOI: 10.1128/JCM.00972-15. View

Rogers B, Shankar P, Jerris R, Kotzbauer D, Anderson E, Watson J . Impact of a rapid respiratory panel test on patient outcomes. Arch Pathol Lab Med. 2014; 139(5):636-41. DOI: 10.5858/arpa.2014-0257-OA. View

Suryaprasad A, Redd J, Ricks P, Podewils L, Brett M, Oski J . Effect of rapid influenza diagnostic testing on antiviral treatment decisions for patients with influenza-like illness: southwestern U.S., May-December 2009. Public Health Rep. 2014; 129(4):322-7. PMC: 4037457. DOI: 10.1177/003335491412900406. View

Abanses J, Dowd M, Simon S, Sharma V . Impact of rapid influenza testing at triage on management of febrile infants and young children. Pediatr Emerg Care. 2006; 22(3):145-9. DOI: 10.1097/01.pec.0000202454.19237.b0. View

Benito-Fernandez J, Vazquez-Ronco M, Morteruel-Aizkuren E, Mintegui-Raso S, Sanchez-Etxaniz J, Fernandez-Landaluce A . Impact of rapid viral testing for influenza A and B viruses on management of febrile infants without signs of focal infection. Pediatr Infect Dis J. 2006; 25(12):1153-7. DOI: 10.1097/01.inf.0000246826.93142.b0. View

Taubenberger J, Morens D . The pathology of influenza virus infections. Annu Rev Pathol. 2007; 3:499-522. PMC: 2504709. DOI: 10.1146/annurev.pathmechdis.3.121806.154316. View

10.

Ko F, Drews S . The impact of commercial rapid respiratory virus diagnostic tests on patient outcomes and health system utilization. Expert Rev Mol Diagn. 2017; 17(10):917-931. DOI: 10.1080/14737159.2017.1372195. View

11.

Ozkaya E, Cambaz N, Coskun Y, Mete F, Geyik M, Samanci N . The effect of rapid diagnostic testing for influenza on the reduction of antibiotic use in paediatric emergency department. Acta Paediatr. 2009; 98(10):1589-92. DOI: 10.1111/j.1651-2227.2009.01384.x. View

12.

Singh S . Middle East Respiratory Syndrome Virus Pathogenesis. Semin Respir Crit Care Med. 2016; 37(4):572-7. PMC: 7171719. DOI: 10.1055/s-0036-1584796. View

13.

Falsey A, Murata Y, Walsh E . Impact of rapid diagnosis on management of adults hospitalized with influenza. Arch Intern Med. 2007; 167(4):354-60. DOI: 10.1001/archinte.167.4.ioi60207. View

14.

Berthod D, Genton B, Hatz C, Blum J, De Valliere S . Ability of physicians to diagnose influenza and usefulness of a rapid influenza antigen test in febrile returning travelers: A randomized controlled trial. Travel Med Infect Dis. 2015; 13(5):394-9. DOI: 10.1016/j.tmaid.2015.08.001. View

15.

Wahrenbrock M, Matushek S, Boonlayangoor S, Tesic V, Beavis K, Charnot-Katsikas A . Comparison of Cepheid Xpert Flu/RSV XC and BioFire FilmArray for Detection of Influenza A, Influenza B, and Respiratory Syncytial Virus. J Clin Microbiol. 2016; 54(7):1902-1903. PMC: 4922080. DOI: 10.1128/JCM.00084-16. View

16.

Blaschke A, Shapiro D, Pavia A, Byington C, Ampofo K, Stockmann C . A National Study of the Impact of Rapid Influenza Testing on Clinical Care in the Emergency Department. J Pediatric Infect Dis Soc. 2014; 3(2):112-8. PMC: 4036423. DOI: 10.1093/jpids/pit071. View

17.

. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections. The MIST (Management of Influenza in the Southern Hemisphere Trialists) Study Group. Lancet. 1998; 352(9144):1877-81. View

18.

Tovey E, Stelzer-Braid S, Toelle B, Oliver B, Reddel H, Willenborg C . Rhinoviruses significantly affect day-to-day respiratory symptoms of children with asthma. J Allergy Clin Immunol. 2014; 135(3):663-9.e12. PMC: 7173323. DOI: 10.1016/j.jaci.2014.10.020. View

19.

Esposito S, Marchisio P, Morelli P, Crovari P, Principi N . Effect of a rapid influenza diagnosis. Arch Dis Child. 2003; 88(6):525-6. PMC: 1763129. DOI: 10.1136/adc.88.6.525. View

20.

Jeong H, Heo J, Park J, Kim W . Effect of the influenza virus rapid antigen test on a physician's decision to prescribe antibiotics and on patient length of stay in the emergency department. PLoS One. 2014; 9(11):e110978. PMC: 4222913. DOI: 10.1371/journal.pone.0110978. View