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Gonnabathula P, Choi MK, Li M, Kabadi SV, Fairman K. Utility of life stage-specific chemical risk assessments based on New Approach Methodologies (NAMs). Food Chem Toxicol 2024; 190:114789. [PMID: 38844066 DOI: 10.1016/j.fct.2024.114789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 06/17/2024]
Abstract
The safety assessments for chemicals targeted for use or expected to be exposed to specific life stages, including infancy, childhood, pregnancy and lactation, and geriatrics, need to account for extrapolation of data from healthy adults to these populations to assess their human health risk. However, often adequate and relevant toxicity or pharmacokinetic (PK) data of chemicals in specific life stages are not available. For such chemicals, New Approach Methodologies (NAMs), such as physiologically based pharmacokinetic (PBPK) modeling, biologically based dose response (BBDR) modeling, in vitro to in vivo extrapolation (IVIVE), etc. can be used to understand the variability of exposure and effects of chemicals in specific life stages and assess their associated risk. A life stage specific PBPK model incorporates the physiological and biochemical changes associated with each life stage and simulates their impact on the absorption, distribution, metabolism, and elimination (ADME) of these chemicals. In our review, we summarize the parameterization of life stage models based on New Approach Methodologies (NAMs) and discuss case studies that highlight the utility of a life stage based PBPK modeling for risk assessment. In addition, we discuss the utility of artificial intelligence (AI)/machine learning (ML) and other computational models, such as those based on in vitro data, as tools for estimation of relevant physiological or physicochemical parameters and selection of model. We also discuss existing gaps in the available toxicological datasets and current challenges that need to be overcome to expand the utility of NAMs for life stage-specific chemical risk assessment.
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Affiliation(s)
- Pavani Gonnabathula
- Division of Biochemical Toxicology, National Center for Toxicological Research (NCTR), US Food and Drug Administration (FDA), Jefferson, AR, 72079, USA
| | - Me-Kyoung Choi
- Division of Biochemical Toxicology, National Center for Toxicological Research (NCTR), US Food and Drug Administration (FDA), Jefferson, AR, 72079, USA
| | - Miao Li
- Division of Biochemical Toxicology, National Center for Toxicological Research (NCTR), US Food and Drug Administration (FDA), Jefferson, AR, 72079, USA
| | - Shruti V Kabadi
- Center for Food Safety and Applied Nutrition (CFSAN), US Food and Drug Administration (FDA), College Park, MD, 20740, USA
| | - Kiara Fairman
- Division of Biochemical Toxicology, National Center for Toxicological Research (NCTR), US Food and Drug Administration (FDA), Jefferson, AR, 72079, USA.
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Shen YJ, Lien CE, Chou YJ, Tsai T, Huang N. Prescribing antibiotics for children with dengue infection in Taiwan: who are at risk and who are high prescribers? Int J Qual Health Care 2024; 36:mzae052. [PMID: 38878061 PMCID: PMC11197962 DOI: 10.1093/intqhc/mzae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/28/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
Inappropriate antibiotic use contributes to antimicrobial resistance, a global public health threat. The non-specific manifestations of dengue, itself a growing public health threat, lead to avoidable empiric antibiotic prescription, particularly in children. In this national pooled population-based cross-sectional study, we evaluated child and physician characteristics associated with antibiotics prescription in confirmed dengue cases in Taiwan. Linking national health care insurance claims and reports of confirmed dengue cases from 2008 to 2015, there were 7086 children with confirmed dengue with 21 744 outpatient visits and 2520 inpatient admissions. We assessed the presence of antibiotic prescription in outpatient and inpatient settings separately a week before or after the confirmation date. Logistic regression models with generalized estimating equations were applied to identify patient, practitioner, and other factors associated with antibiotic prescription. A total of 29.4% of children <18 years old with dengue who did not have a concomitant bacterial infection were prescribed antibiotics during the 14-day assessment period. Antibiotics prescription was reduced from 13.5% to 6.3% and from 43.2% to 19.3% in outpatient and inpatient settings, respectively, after dengue was confirmed. Young children were more likely to receive antibiotics. Significant variations in antibiotic prescribing across physicians were observed only in outpatient settings: physicians ≥60 years old and physicians practicing at clinics and in non-urban facilities were more likely to prescribe antibiotics. Antibiotics were less likely to be prescribed during an exceptional 2-year epidemic than in other years. Antibiotic prescribing for dengue, an arboviral infection affecting half of the global population, was shown to occur in 29% of paediatric cases in Taiwan. That potentially avoidable antibiotic consumption could be reduced by improving antibiotic stewardship, informed by understanding the conditions under which antibiotics are prescribed and the availability of prevention strategies for viral diseases, including dengue. We identified a number of such factors in this national population-based study.
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Affiliation(s)
- Yi-Jung Shen
- Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, United States
| | - Chia-En Lien
- Medigen Vaccine Biologics Corporation, Taipei 114, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County 260, Taiwan
| | | | - Nicole Huang
- Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
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Schober T, Wong K, DeLisle G, Caya C, Brendish NJ, Clark TW, Dendukuri N, Doan Q, Fontela PS, Gore GC, Li P, McGeer AJ, Noël KC, Robinson JL, Suarthana E, Papenburg J. Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments: A Systematic Review and Meta-Analysis. JAMA Intern Med 2024; 184:528-536. [PMID: 38436951 PMCID: PMC10913011 DOI: 10.1001/jamainternmed.2024.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 03/05/2024]
Abstract
Importance Rapid tests for respiratory viruses, including multiplex panels, are increasingly available in emergency departments (EDs). Their association with patient outcomes remains unclear. Objective To determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) was associated with decreased antibiotic use, ancillary tests, ED length of stay, and ED return visits and hospitalization and increased influenza antiviral treatment. Data Sources Ovid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022. Study Selection Randomized clinical trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. Main Outcomes and Measures Antibiotic use and secondary outcomes were pooled separately as risk ratios (RRs) and risk difference estimates with 95% CIs. Results Of 7157 studies identified, 11 (0.2%; n = 6068 patients) were included in pooled analyses. Routine rapid viral testing was not associated with antibiotic use (RR, 0.99; 95% CI, 0.93-1.05; high certainty) but was associated with higher use of influenza antivirals (RR, 1.33; 95% CI, 1.02-1.75; moderate certainty) and lower use of chest radiography (RR, 0.88; 95% CI, 0.79-0.98; moderate certainty) and blood tests (RR, 0.81; 95% CI, 0.69-0.97; moderate certainty). There was no association with urine testing (RR, 0.95; 95% CI, 0.77-1.17; low certainty), ED length of stay (0 hours; 95% CI, -0.17 to 0.16; moderate certainty), return visits (RR, 0.93; 95%, CI 0.79-1.08; moderate certainty) or hospitalization (RR, 1.01; 95% CI, 0.95-1.08; high certainty). Adults represented 963 participants (16%). There was no association of viral testing with antibiotic use in any prespecified subgroup by age, test method, publication date, number of viral targets, risk of bias, or industry funding. Conclusions and Relevance The results of this systematic review and meta-analysis suggest that there are limited benefits of routine viral testing in EDs for patients with ARI. Further studies in adults, especially those with high-risk conditions, are warranted.
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Affiliation(s)
- Tilmann Schober
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kimberly Wong
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Gaëlle DeLisle
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Chelsea Caya
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathan J Brendish
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, England
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, England
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, England
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, England
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Nandini Dendukuri
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia S Fontela
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Genevieve C Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Patricia Li
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Allison J McGeer
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Kim Chloe Noël
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- Health Technology Assessment Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Rankin DA, Katz SE, Amarin JZ, Hayek H, Stewart LS, Slaughter JC, Deppen S, Yanis A, Romero YH, Chappell JD, Khankari NK, Halasa NB. Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e29. [PMID: 38500720 PMCID: PMC10945942 DOI: 10.1017/ash.2024.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/20/2024]
Abstract
Objective Evaluate the association between provider-ordered viral testing and antibiotic treatment practices among children discharged from an ED or hospitalized with an acute respiratory infection (ARI). Design Active, prospective ARI surveillance study from November 2017 to February 2020. Setting Pediatric hospital and emergency department in Nashville, Tennessee. Participants Children 30 days to 17 years old seeking medical care for fever and/or respiratory symptoms. Methods Antibiotics prescribed during the child's ED visit or administered during hospitalization were categorized into (1) None administered; (2) Narrow-spectrum; and (3) Broad-spectrum. Setting-specific models were built using unconditional polytomous logistic regression with robust sandwich estimators to estimate the adjusted odds ratios and 95% confidence intervals between provider-ordered viral testing (ie, tested versus not tested) and viral test result (ie, positive test versus not tested and negative test versus not tested) and three-level antibiotic administration. Results 4,107 children were enrolled and tested, of which 2,616 (64%) were seen in the ED and 1,491 (36%) were hospitalized. In the ED, children who received a provider-ordered viral test had 25% decreased odds (aOR: 0.75; 95% CI: 0.54, 0.98) of receiving a narrow-spectrum antibiotic during their visit than those without testing. In the inpatient setting, children with a negative provider-ordered viral test had 57% increased odds (aOR: 1.57; 95% CI: 1.01, 2.44) of being administered a broad-spectrum antibiotic compared to children without testing. Conclusions In our study, the impact of provider-ordered viral testing on antibiotic practices differed by setting. Additional studies evaluating the influence of viral testing on antibiotic stewardship and antibiotic prescribing practices are needed.
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Affiliation(s)
- Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sophie E. Katz
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin Z. Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Haya Hayek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura S. Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C. Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen Deppen
- Department of Thoracic Surgery and Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nikhil K. Khankari
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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Ferrani S, Prazuck T, Béchet S, Lesne F, Cohen R, Levy C. Diagnostic accuracy of a rapid antigen triple test (SARS-CoV-2, respiratory syncytial virus, and influenza) using anterior nasal swabs versus multiplex RT-PCR in children in an emergency department. Infect Dis Now 2023; 53:104769. [PMID: 37572988 DOI: 10.1016/j.idnow.2023.104769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND In children, respiratory infections such as SARS-CoV-2, respiratory syncytial virus (RSV), and influenza share similar clinical signs and symptoms. Here we compared the performance of a rapid antigen diagnostic test using a self-collected anterior nasal swab (COVID-VIRO ALL IN TRIPLEX) and multiplex RT-PCR. METHODS From October to December 2022, in the emergency pediatrics unit of Orleans Hospital, France, we evaluated the diagnostic accuracy of the triplex test. RESULTS For the 263 children, sensitivity of the test was 88.9% (95%CI 51.8-99.7), 79.1% (95%CI 64.0-90.0), and 91.6% (95%CI 84.1-96.3), for SARS-CoV-2, RSV, and influenza, respectively. Specificity was 100% for each virus. For RT-PCR with cycle threshold < 32, sensitivity was 100.0% [95%CI 59.0-100.0], 87.2% [95%CI 72.6-95.7] and 92.3% [95%CI 84.896.9] for SARS-CoV-2, RSV, and influenza respectively. CONCLUSIONS This easy-to-perform triplex test is a considerable advance, allowing clinicians to obtain an accurate diagnosis in most cases of respiratory infection. More data are needed to validate this test in different contexts and across several seasons.
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Affiliation(s)
| | | | - Stéphane Béchet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
| | - Fabien Lesne
- Département de biologie, CHR Orleans, Orleans, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; AFPA, Association Française de Pédiatrie Ambulatoire, Paris, France; Research Center, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, France; GEMINI, Groupe de Recherche Clinique-Groupe d'Etude des Maladies Infectieuses Néonatales et Infantiles, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; AFPA, Association Française de Pédiatrie Ambulatoire, Paris, France; Research Center, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, France; GEMINI, Groupe de Recherche Clinique-Groupe d'Etude des Maladies Infectieuses Néonatales et Infantiles, Institut Mondor de Recherche Biomédicale, Créteil, France.
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Stamm BD, Tamerius J, Reddy S, Barlow S, Hamer C, Kempken A, Goss M, He C, Bell C, Arnold M, Checovich M, Temte E, Norton D, Chen G, Baltus J, Gurley ES, Temte JL. The Influence of Rapid Influenza Diagnostic Testing on Clinician Decision-Making for Patients With Acute Respiratory Infection in Urgent Care. Clin Infect Dis 2023; 76:1942-1948. [PMID: 36723863 PMCID: PMC10249985 DOI: 10.1093/cid/ciad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The potential benefits of using rapid influenza diagnostic tests (RIDTs) in urgent care facilities for clinical care and prescribing practices are understudied. We compared antiviral and antibiotic prescribing, imaging, and laboratory ordering in clinical encounters with and without RIDT results. METHODS We compared patients with acute respiratory infection (ARI) symptoms who received an RIDT and patients who did not at 2 urgent care facilities. Primary analysis using 1-to-1 exact matching resulted in 1145 matched pairs to which McNemar 2 × 2 tests were used to assess the association between the likelihood of prescribing, imaging/laboratory ordering, and RIDT use. Secondary analysis compared the same outcomes using logistic regression among the RIDT-tested population between participants who tested negative (RIDT(-)) and positive (RIDT(+)). RESULTS Primary analysis revealed that compared to the non-RIDT-tested population, RIDT(+) patients 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, .08-.27). Comparing RIDT-tested to non-RIDT-tested participants, RIDT use increased antiviral prescribing odds (OR, 3.07; 95% CI, 2.25-4.26) and reduced antibiotic prescribing odds (OR, 0.52; 95% CI, .43-.63). Secondary analysis identified increased odds of prescribing antivirals (OR, 28.21; 95% CI, 18.15-43.86) and decreased odds of prescribing antibiotics (OR, 0.20; 95% CI, .13-.30) for RIDT(+) participants compared with RIDT(-). CONCLUSIONS Use of RIDTs in patients presenting with ARI symptoms influences clinician diagnostic and treatment decision-making, which could lead to improved patient outcomes, population-level reductions in influenza burden, and a decreased threat of antibiotic resistance.
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Affiliation(s)
- Brian D Stamm
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | | | | | - Shari Barlow
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Caroline Hamer
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Ashley Kempken
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Maureen Goss
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Cecilia He
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Cristalyne Bell
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Mitchell Arnold
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Mary Checovich
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Emily Temte
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Derek Norton
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Guanhua Chen
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Jeffrey Baltus
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Emily S Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan L Temte
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
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Shaukat H, Wang S, Kim D, Koutroulis I, Berkowitz D, Breslin K. Practice patterns and perceptions of influenza testing amongst pediatric urgent care providers. Diagn Microbiol Infect Dis 2023; 105:115818. [PMID: 36241541 DOI: 10.1016/j.diagmicrobio.2022.115818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Despite a sensitivity of 50% to 70% the rapid influenza diagnostic test (RIDT) continues to play an important role in clinical decision-making due to its quick turn-around time, high specificity, relative simplicity of use, and low cost. METHODS A quantitative study using a web-based survey was distributed to 110 members of the Society of Pediatric Urgent Care aimed to assess RIDT use for diagnosis and management of influenza in outpatient pediatric patients. RESULTS Responses from 61 providers were received. Forty-two percent (95% CI 29.5-54.5%) of respondents report higher confidence in their diagnosis of influenza with the aid of a positive RIDT. 28% of respondents (95% CI 16.6-39.4%) report a higher likelihood of prescribing antiviral medications to low-risk patients if an RIDT is positive than without laboratory confirmation. CONCLUSION Most pediatric urgent care respondents reported higher confidence in their diagnosis and higher likelihood of prescribing antivirals with a positive RIDT rather than by clinical symptoms alone.
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Affiliation(s)
- Haroon Shaukat
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Sophia Wang
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA
| | - Dana Kim
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA
| | - Ioannis Koutroulis
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Deena Berkowitz
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kristen Breslin
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Cheong HS, Park KH, Kim HB, Kim SW, Kim B, Moon C, Lee MS, Yoon YK, Jeong SJ, Kim YC, Eun BW, Lee H, Shin JY, Kim HS, Hwang IS, Park CS, Kwon KT. Core Elements for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals. Infect Chemother 2022; 54:637-673. [PMID: 36596679 PMCID: PMC9840955 DOI: 10.3947/ic.2022.0171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Currently, antimicrobial resistance (AMR) is a major threat to global public health. The antimicrobial stewardship program (ASP) has been proposed as an important approach to overcome this crisis. ASP supports the optimal use of antimicrobials, including appropriate dosing decisions, administration duration, and administration routes. In Korea, efforts are being made to overcome AMR using ASPs as a national policy. The current study aimed to develop core elements of ASP that could be introduced in domestic medical facilities. A Delphi survey was conducted twice to select the core elements through expert consensus. The core elements for implementing the ASP included (1) leadership commitment, (2) operating system, (3) action, (4) tracking, (5) reporting, and (6) education. To ensure these core elements are present at medical facilities, multiple departments must collaborate as teams for ASP operations. Establishing a reimbursement system and a workforce for ASPs are prerequisites for implementing ASPs. To ensure that ASP core elements are actively implemented in medical facilities, it is necessary to provide financial support for ASPs in medical facilities, nurture the healthcare workforce in performing ASPs, apply the core elements to healthcare accreditation, and provide incentives to medical facilities by quality evaluation criteria.
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Affiliation(s)
- Hae Suk Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chisook Moon
- Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Mi Suk Lee
- Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Nowon Eulji University Hospital, Seoul, Korea
| | - Hyukmin Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyung-sook Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In Sun Hwang
- Korea Institute for Healthcare Accreditation, Seoul, Korea
| | - Choon-Seon Park
- Health Insurance Review and Assessment Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Bibby HL, de Koning L, Seiden-Long I, Zelyas N, Church DL, Berenger BM. A pragmatic randomized controlled trial of rapid on-site influenza and respiratory syncytial virus PCR testing in paediatric and adult populations. BMC Infect Dis 2022; 22:854. [PMID: 36384484 PMCID: PMC9667852 DOI: 10.1186/s12879-022-07796-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Rapid/point-of-care respiratory virus nucleic acid tests (NAT) may improve oseltamivir, antibiotic, diagnostic test, and hospital bed utilization. Previous randomized controlled trials (RCT) on this topic have not used standard procedures of an accredited healthcare and laboratory system. Methods We conducted a parallel RCT at two hospitals [paediatric = Alberta Children’s Hospital (ACH); primarily adult = Peter Lougheed Centre (PLC)]. Patients with a respiratory viral testing order were randomized to testing at either a central accredited laboratory (standard arm) or with a rapid polymerase chain reaction test at an on-site accredited laboratory followed by standard testing [rapid on-site test (ROST) arm] based on day of specimen receipt at the laboratory. Patients and clinicians were blinded to assignment. The primary outcome for ACH was inpatient length of stay (LOS) and for PLC was the proportion of inpatients prescribed oseltamivir. Results 706 patient encounters were included at ACH; 322 assigned to ROST (181 inpatients) and 384 to the standard arm (194 inpatients). 422 patient encounters were included at PLC; 200 assigned to ROST (157 inpatients) and 222 to the standard arm (175 inpatients). The rate of oseltamivir prescription and number of doses given was reduced in PLC inpatients negative for influenza in the ROST arm compared to standard arm [mean 14.9% (95% CI 9.87–21.9) vs. 27.5% (21.0–35.2), p = 0.0135; mean 2.85 doses (SEM 2.39–3.32) vs. 4.17 doses (3.85–4.49) p = 0.022, respectively]. ROST also significantly reduced oseltamivir use at ACH, reduced chest radiographs (ACH), and laboratory test ordering (PLC), but not antibiotic prescriptions. ROST also reduced the median turnaround time by > 24 h (ACH and PLC). The LOS at ACH was not significantly different between the ROST and standard arms [median 4.05 days (SEM 1.79–18.2) vs 4.89 days (2.07–22.9), p = 0.062, respectively]. No adverse events were reported. Conclusions In a RCT representing implementation of ROST in an accredited laboratory system, we found that a ROST improved oseltamivir utilization and is the first RCT to show reduced ancillary testing in both paediatric and adult populations. A larger study is required to assess reduction in paediatric LOS as ACH was underpowered. These findings help justify the implementation of rapid on-site respiratory virus testing for inpatients. Trial registration ISRCTN, number 10110119, Retrospectively Registered, 01/12/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07796-3.
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Brigadoi G, Gastaldi A, Moi M, Barbieri E, Rossin S, Biffi A, Cantarutti A, Giaquinto C, Da Dalt L, Donà D. Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11091192. [PMID: 36139971 PMCID: PMC9494981 DOI: 10.3390/antibiotics11091192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Fever is one of the most common causes of medical evaluation of children, and early discrimination between viral and bacterial infection is essential to reduce inappropriate prescriptions. This study aims to systematically review the effects of point-of-care tests (POCTs) and rapid tests for respiratory tract infections on changing antibiotic prescription rate, length of stay, duration of therapy, and healthcare costs. Embase, MEDLINE, and Cochrane Library databases were systematically searched. All randomized control trials and non-randomized observational studies meeting inclusion criteria were evaluated using the NIH assessment tool. A meta-analysis was performed to assess the effects of rapid influenza diagnostic tests and film-array respiratory panel implementation on selected outcomes. From a total of 6440 studies, 57 were eligible for the review. The analysis was stratified by setting and POCT/rapid test type. The most frequent POCTs or rapid tests implemented were the Rapid Influenza Diagnostic Test and film-array and for those types of test a separate meta-analysis assessed a significant reduction in antibiotic prescription and an improvement in oseltamivir prescription. Implementing POCTs and rapid tests to discriminate between viral and bacterial infections for respiratory pathogens is valuable for improving appropriate antimicrobial prescriptions. However, more studies are needed to assess these findings in pediatric settings.
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Affiliation(s)
- Giulia Brigadoi
- Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-3476959589
| | - Andrea Gastaldi
- Department of Pediatrics, Women’s and Children’s Health, University of Verona, Piazz. Stefani 1, 37126 Verona, Italy
| | - Marco Moi
- Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Sara Rossin
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Via Giustiani 3, 35128 Padua, Italy
| | - Annalisa Biffi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Via Giustiani 3, 35128 Padua, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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11
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Yin N, Van Nuffelen M, Bartiaux M, Préseau T, Roggen I, Delaunoy S, Mahadeb B, Dahma H, Busson L, Vandenberg O, Hallin M. Clinical impact of the rapid molecular detection of RSV and influenza A and B viruses in the emergency department. PLoS One 2022; 17:e0274222. [PMID: 36054246 PMCID: PMC9439204 DOI: 10.1371/journal.pone.0274222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Using respiratory virus rapid diagnostic tests in the emergency department could allow better and faster clinical management. Point-of-care PCR instruments now provide results in less than 30 minutes. The objective of this study was to assess the impact of the use of a rapid molecular diagnostic test, the cobas® Influenza A/B & RSV Assay, during the clinical management of emergency department patients. Methods Patients (adults and children) requiring admission or suffering from an underlying condition at risk of respiratory complications were prospectively recruited in the emergency department of four hospitals in the Brussels region. Physicians’ intentions regarding admission, isolation, antibiotic, and antiviral use were collected before and after performing the rapid molecular test. Additionally, a comparison of the analytical performance of this test against antigen rapid tests and viral culture was performed as well as a time-to-result evaluation. Results Among the 293 patients recruited, 90 had a positive PCR, whereas 44 had a positive antigen test. PCR yielded a sensitivity of 100% for all targets. Antigen tests yielded sensitivities ranging from 66.7% for influenza B to 83.3% for respiratory syncytial virus (RSV). The use of PCR allowed a decrease in the overall need for isolation and treatment by limiting the isolation of negative patients and antibiotic use for positive patients. Meanwhile, antiviral treatments better targeted patients with a positive influenza PCR. Conclusion The use of a rapid influenza and RSV molecular test improves the clinical management of patients admitted to the emergency department by providing a fast and reliable result. Their additional cost compared to antigen tests should be balanced with the benefit of their analytical performance, leading to efficient reductions in the need for isolation and antibiotic use.
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Affiliation(s)
- Nicolas Yin
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles–Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
- * E-mail:
| | - Marc Van Nuffelen
- Emergency Department, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Magali Bartiaux
- Emergency Department, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Préseau
- Emergency Department, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Inge Roggen
- Emergency Department, Queen Fabiola Pediatric University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sabrina Delaunoy
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles–Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Bhavna Mahadeb
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles–Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hafid Dahma
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles–Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Laurent Busson
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles–Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Olivier Vandenberg
- Clinical Research and Innovation Unit, Laboratoire Hospitalier Universitaire de Bruxelles–Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Marie Hallin
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles–Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
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12
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Mattila S, Paalanne N, Honkila M, Pokka T, Tapiainen T. Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2216162. [PMID: 35679047 PMCID: PMC9185185 DOI: 10.1001/jamanetworkopen.2022.16162] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Limited data are available on the clinical impact of multiplex polymerase chain reaction (PCR) point-of-care testing for respiratory pathogens in acutely ill children. OBJECTIVE To evaluate the effect of multiplex PCR point-of-care testing for respiratory pathogens on antibiotic use in acutely ill children. DESIGN, SETTING, AND PARTICIPANTS This unblinded, randomized clinical trial was conducted from May 6, 2019, through March 12, 2020. The participants were followed up until hospitalization or discharge from the emergency department (ED) for primary outcome. The study was conducted at the pediatric ED of Oulu University Hospital, Finland. Eligible study participants were children aged 0 to 17 years with fever and/or any respiratory signs or symptoms. Children with underlying medical conditions were included. The statistical analyses were performed between August 11, 2020, and September 14, 2021. INTERVENTIONS The participants were randomly assigned in a 2:1 ratio either to undergo multiplex PCR point-of-care testing (18 respiratory viruses and 3 bacteria with results ready within 70 minutes) upon arrival at the ED or to receive routine care. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of children receiving antibiotic therapy. The secondary outcomes were the numbers of diagnostic tests and radiographic imaging procedures performed and costs. RESULTS A total of 1417 children were assessed for eligibility. After exclusions, 1243 children (692 boys [56%]) were randomly allocated to either the intervention (829 children) or control (414 children) group. The mean (SD) age of the participants was 3.0 (3.6) years in the intervention group (median [IQR], 1.7 [0.4-4.1] years) and 3.0 (3.5) years (median [IQR], 1.9 [0.4-4.1] years) in the control group. Multiplex PCR point-of-care testing for respiratory pathogens did not reduce the overall prescribing of antibiotics in the emergency department (226 children [27.3%] in the intervention group vs 118 children [28.5%] in the control group; risk ratio, 0.96; 95% CI, 0.79-1.16). Targeted antibiotic therapy was started in 12 children (1.4%) tested with point-of-care multiplex PCR and 2 children (0.5%) in the control group (risk ratio, 3.0; 95% CI, 0.76-11.9). The numbers of diagnostic tests did not differ between the groups, nor did the costs. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, point-of-care testing for respiratory pathogens did not reduce the use of antibiotics at the pediatric ED. Testing for respiratory pathogens appears to have a limited impact on clinical decision-making for acutely ill children. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03932942.
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Affiliation(s)
- Suvi Mattila
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- PEDEGO (Pediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Niko Paalanne
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- PEDEGO (Pediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Minna Honkila
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- PEDEGO (Pediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- PEDEGO (Pediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- PEDEGO (Pediatrics, Dermatology, Gynecology, Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Finland
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Lee JY, Baek SH, Ahn JG, Yoon SH, Kim MK, Kim SY, Kim KW, Sohn MH, Kang JM. Delayed Influenza Treatment in Children With False-Negative Rapid Antigen Test: A Retrospective Single-Center Study in Korea 2016-2019. J Korean Med Sci 2022; 37:e3. [PMID: 34981679 PMCID: PMC8723894 DOI: 10.3346/jkms.2022.37.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We aimed to examine the delay in antiviral initiation in rapid antigen test (RAT) false-negative children with influenza virus infection and to explore the clinical outcomes. We additionally conducted a medical cost-benefit analysis. METHODS This single-center, retrospective study included children (aged < 10 years) with influenza-like illness (ILI), hospitalized after presenting to the emergency department during three influenza seasons (2016-2019). RAT-false-negativity was defined as RAT-negative and polymerase chain reaction-positive cases. The turnaround time to antiviral treatment (TAT) was from the time when RAT was prescribed to the time when the antiviral was administered. The medical cost analysis by scenarios was also performed. RESULTS A total of 1,430 patients were included, 7.5% were RAT-positive (n = 107) and 2.4% were RAT-false-negative (n = 20). The median TAT of RAT-false-negative patients was 52.8 hours, significantly longer than that of 4 hours in RAT-positive patients (19.2-100.1, P < 0.001). In the multivariable analysis, TAT of ≥ 24 hours was associated with a risk of severe influenza infection and the need for mechanical ventilation (odds ratio [OR], 6.8, P = 0.009 and OR, 16.2, P = 0.033, respectively). The medical cost varied from $11.7-187.3/ILI patient. CONCLUSION Antiviral initiation was delayed in RAT-false-negative patients. Our findings support the guideline that children with influenza, suspected of having severe or progressive infection, should be treated immediately.
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Affiliation(s)
- Ji Young Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hwan Baek
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Hee Yoon
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Kyu Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea.
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Ciccone EJ, Kabugho L, Baguma E, Muhindo R, Juliano JJ, Mulogo E, Boyce RM. Rapid Diagnostic Tests to Guide Case Management of and Improve Antibiotic Stewardship for Pediatric Acute Respiratory Illnesses in Resource-Constrained Settings: a Prospective Cohort Study in Southwestern Uganda. Microbiol Spectr 2021; 9:e0169421. [PMID: 34817224 PMCID: PMC8612158 DOI: 10.1128/spectrum.01694-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022] Open
Abstract
Pediatric acute respiratory illness (ARI) is one of the most common reasons for evaluation at peripheral health centers in sub-Saharan Africa and is frequently managed based on clinical syndrome alone. Although most ARI episodes are likely caused by self-limited viral infections, the majority are treated with antibiotics. This overuse contributes to the development of antimicrobial resistance. To evaluate the preliminary feasibility and potential impact of adding pathogen-specific and clinical biomarker diagnostic testing to existing clinical management algorithms, we conducted a prospective, observational cohort study of 225 children presenting with malaria-negative, febrile ARI to the outpatient department of a semi-urban peripheral health facility in southwestern Uganda from October 2019 to January 2020. In addition to routine clinical evaluation, we performed influenza and Streptococcus pneumoniae antigen testing and measured levels of C-reactive protein, procalcitonin, and lactate in the clinic's laboratory, and conducted a follow-up assessment by phone 7 days later. Almost one-fifth of participants (40/225) tested positive for influenza. Clinical biomarker measurements were low with C-reactive protein of >40 mg/L in only 11% (13/222) of participants and procalcitonin >0.25 ng/mL in only 13% (16/125). All but two children received antibiotic treatment; only 3% (7/225) were admitted. At follow-up, 59% (118/201) of caregivers reported at least one persistent symptom, but fever had resolved for all children. Positive influenza testing was associated with persistent symptoms. In summary, we demonstrate that simple, rapid pathogen-specific testing and biomarker measurement are possible in resource-limited settings and could improve syndromic management and, in turn, antibiotic stewardship. IMPORTANCE Globally, respiratory illness is one of the most common reasons that children seek care. It is often treated inappropriately with antibiotics, which can drive the development of antibiotic resistance. In resource-rich settings, testing for specific pathogens or measurement of clinical biomarkers, such as procalcitonin and C-reactive protein, is often employed to help determine which children should receive antibiotics. However, there are limited data on the use of these tests in resource-constrained, outpatient contexts in sub-Saharan Africa. We enrolled children with respiratory illness presenting to a clinic in southwestern Uganda and performed testing for influenza, Streptococcus pneumoniae, C-reactive protein, and procalcitonin on-site. Almost all children received antibiotics. We demonstrate that employing clinical algorithms that include influenza and clinical biomarker testing could significantly decrease antibiotic prescriptions. Our study therefore provides preliminary data to support the feasibility and potential utility of diagnostics to improve management of respiratory illness in resource-constrained settings.
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Affiliation(s)
- Emily J. Ciccone
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Lydia Kabugho
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Baguma
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rabbison Muhindo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan J. Juliano
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ross M. Boyce
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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15
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Phetcharakupt V, Pasomsub E, Kiertiburanakul S. Clinical manifestations of influenza and performance of rapid influenza diagnostic test: A university hospital setting. Health Sci Rep 2021; 4:e408. [PMID: 34622032 PMCID: PMC8485631 DOI: 10.1002/hsr2.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Rapid influenza diagnostic test (RIDT) is a diagnostic tool that detects the influenza virus nucleoprotein antigen. The RIDT is widely used in clinical practice because it is simple and cost-effective, and provides results within 10-15 minutes. OBJECTIVE We aimed at evaluating the sensitivity and specificity of the Sofia® RIDT compared with the Luminex® multiplex polymerase chain reaction (PCR). The other goal was to determine the predicting factors for diagnosing influenza among individuals with influenza-like illness (ILI). METHOD Patients with ILI who had the results of both tests were retrospectively reviewed. We determined the performances of the RIDT. RESULTS A total of 473 patients were included with a median age of 58 (interquartile range 41-74) years. Of these, 47.1% were male, and 16.2% were diagnosed with influenza by the RIDT or RT-PCR's positive test. For influenza A, the RIDT showed a sensitivity of 76.3% (95% confidence interval [CI] 59.8-88.6) and a specificity of 97.9% (95% CI 96.1-99.0), whereas for influenza B, it showed a sensitivity of 47.1% (95% CI 23.0-72.2) and a specificity of 97.1% (95% CI 95.2-98.5). Patients with influenza were more likely to present with fever (81.8% vs 63.1%), cough (81.8% vs 66.1%), and rhinorrhea (41.6% vs 26.5%) compared to those without influenza (P < 0.05, all), and had a higher proportion of pneumonia (19.5% vs 10.6%, P = 0.029) and acute respiratory distress syndrome (5.2% vs 1.5%, P = 0.063). The predicting factors for influenza among patients presented with ILI were cough (odds ratio [OR] 2.77; 95% CI 0.21-0.81, P = 0.010), rhinorrhea (OR 1.87; 95% CI 1.03-3.36, P = 0.037), and higher body temperature (OR 1.64; 95% CI 1.23-2.19, P = 0.001). CONCLUSIONS The sensitivity of the RIDT for the diagnosis of influenza is fair in contrast to the specificity. Among patients with ILI, cough, rhinorrhea, and higher body temperature might be factors for predicting influenza.
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Affiliation(s)
- Varistha Phetcharakupt
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Ekawat Pasomsub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
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16
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Lam RPK, Chan KL, Cheung ACK, Wong KW, Lau EHY, Chen L, Chaang VK, Woo PCY. The limited value of triage vital signs in predicting influenza infection in children aged 5 years and under in the emergency department: A single-center retrospective cross-sectional study. Medicine (Baltimore) 2021; 100:e27707. [PMID: 34871260 PMCID: PMC8568403 DOI: 10.1097/md.0000000000027707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/19/2021] [Indexed: 01/05/2023] Open
Abstract
Diagnosing influenza in children aged 5 years and under can be challenging because of their difficulty in verbalizing symptoms. This study aimed to explore the value of the triage heart rate (HR), respiratory rate (RR), and temperature, either alone or when combined with individual symptoms and signs, in predicting influenza infection in this age group.This was a retrospective study covering 4 influenza seasons from 2017 to 2019 in an emergency department (ED) in Hong Kong. We recruited patients ≤5 years of age who had an reverse transcription polymerase chain reaction influenza test within 48 hours of ED presentation. The diagnostic performance of the triage HR, RR, and temperature was evaluated as dichotomized or categorized values with diagnostic odds ratios (DORs) calculated based on different age-appropriate thresholds. Linear discriminant analysis was performed to assess the combined discriminatory effect of age, HR, RR, and temperature as continuous variables.Of 322 patients (median age 26 months), 99 had influenza A and 13 had influenza B infection. For HR and RR dichotomized based on age-appropriate thresholds, the DORs ranged from 1.16 to 1.54 and 0.78 to 1.53, respectively. A triage temperature ≥39.0 °C had the highest DOR (3.32) among different degrees of elevation of temperature. The diagnostic criteria that were based on the presence of fever and cough and/or rhinitis symptoms had a higher DOR compared with the Centers for Disease Control and Prevention influenza-like illness criteria (4.42 vs 2.41). However, combining HR, RR, or temperature with such diagnostic criteria added very little to the diagnostic performance. The linear discriminant analysis model had a high specificity of 92.5%, but the sensitivity (18.3%) was too low for clinical use.Triage HR, RR, and temperature had limited value in the diagnosis of influenza in children ≤5 years of age in the ED. Fever and cough and/or rhinitis symptoms had a better diagnostic performance than the Centers for Disease Control and Prevention influenza-like illness criteria in predicting influenza in this age group.
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Affiliation(s)
- Rex Pui Kin Lam
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- 24-hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, Hong Kong Special Administrative Region, China
| | - Kin Ling Chan
- 24-hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, Hong Kong Special Administrative Region, China
| | - Arthur Chi Kin Cheung
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- 24-hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, Hong Kong Special Administrative Region, China
| | - Kin Wa Wong
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- 24-hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, Hong Kong Special Administrative Region, China
| | - Eric Ho Yin Lau
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lujie Chen
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vi Ka Chaang
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Patrick Chiu Yat Woo
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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17
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Lin SW, Shen CF, Liu CC, Cheng CM. A Paper-Based IL-6 Test Strip Coupled With a Spectrum-Based Optical Reader for Differentiating Influenza Severity in Children. Front Bioeng Biotechnol 2021; 9:752681. [PMID: 34692664 PMCID: PMC8527092 DOI: 10.3389/fbioe.2021.752681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/21/2021] [Indexed: 01/08/2023] Open
Abstract
Influenza virus infection is a major worldwide public health problem. Influenza virus infections are associated with a high hospitalization rate in children between the ages of 5 and 14. The predominant reason for poor influenza prognosis is the lack of any effective means for early diagnosis. Early diagnosis of severe illness is critical to improving patient outcome, and could be especially useful in areas with limited medical resources. Accurate, inexpensive, and easy-to-use diagnostic tools could improve early diagnosis and patient outcome, and reduce overall healthcare costs. We developed an interleukin-6 paper-based test strip that used colloidal gold-conjugated antibodies to detect human interleukin-6 protein. These complexes were captured on a paper-based test strip patterned with perpendicular T lines that were pre-coated with anti-human interleukin-6 antibodies. Applied serum samples interacted with these antibodies and presented as colored bands that could be read using a spectrum-based optical reader. The full-spectrum of the reflected light interleukin-6 protein signal could be obtained from the spectral optics module, and the standard could be used to quantitatively analyze interleukin 6 level in serum. We retrospectively evaluated 10 children (23 serum samples) with severe influenza virus infections, 26 children (26 serum samples) with mild influenza virus infections, and 10 healthy children (10 serum samples). Our system, the combined use of a paper-based test strip and a spectrum-based optical reader, provided both qualitative and quantitative information. When used with the optical reader, the detection limit was improved from a qualitative, naked-eye level of 400 pg/ml to a quantitative, optical reader level of 76.85 pg/ml. After monitoring serum interleukin-6 level via our system, we found a high correlation between our system results and those obtainable using a conventional sandwich enzyme-linked immunosorbent assay method (Rho = 0.706, p < 0.001). The sensitivity and specificity for differentiating between severe and mild influenza using our combined method (test strip coupled with optical reader) were 78.3 and 50.0%, respectively. When interleukin-6 was combined with serum C-reaction protein, the sensitivity and specificity were 85.7 and 95.5%, and the receiver operating characteristic area-under-the-curve was quite high (AUC = 0.911, p < 0.001). The potential advantages of our system, i.e., a paper-based test strip coupled with a spectrum-based optical reader, are as follows: 1) simple user operation; 2) rapid turnaround times–within 20 min; 3) high detection performance; and, 4) low-cost fabrication.
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Affiliation(s)
- Sheng-Wen Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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18
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Yoon YK, Kwon KT, Jeong SJ, Moon C, Kim B, Kiem S, Kim HS, Heo E, Kim SW. Guidelines on Implementing Antimicrobial Stewardship Programs in Korea. Infect Chemother 2021; 53:617-659. [PMID: 34623784 PMCID: PMC8511380 DOI: 10.3947/ic.2021.0098] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022] Open
Abstract
These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.,Korean Society for Antimicrobial Therapy, Seoul, Korea
| | - Ki Tae Kwon
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Korean Society of Infectious Diseases, Seoul, Korea
| | - Chisook Moon
- Korean Society of Infectious Diseases, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Bongyoung Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sungmin Kiem
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyung-Sook Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.,Korean Society of Health-System Pharmacist, Seoul, Korea
| | - Eunjeong Heo
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.,Korean Society of Health-System Pharmacist, Seoul, Korea
| | - Shin-Woo Kim
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
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19
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Febrile infants without respiratory symptoms or sick contacts: are chest radiographs or RSV/influenza testing indicated? BMC Infect Dis 2021; 21:862. [PMID: 34425771 PMCID: PMC8381480 DOI: 10.1186/s12879-021-06493-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Serious bacterial infection rates in febrile infants < 60 days are about 8–11%. Less than 1% of febrile infants with no respiratory symptoms will have pneumonia however, chest radiography (CXR) rates remain between 30 and 60%. Rapid Respiratory Syncytial Virus (RSV) and influenza (flu) testing is common, however, there is not enough data to determine if febrile infants without any respiratory symptoms should be tested. The goal of this study is to determine the rate of positive CXR and RSV/flu results in febrile infants with no respiratory symptoms and no sick contacts. Methods Well-appearing febrile infants between 7 and 60 days of age who presented to the pediatric emergency department (PED) from September 1st, 2015 through October 30th, 2017 were enrolled. Demographic data, respiratory symptoms, CXR findings and RSV/flu results were collected. SAS statistical software was used for analysis. Results 129 infants met enrollment criteria. Of the 129 infants, 58 (45.0%) had no respiratory symptoms and no sick contacts. Of these 58, 36 (62.1%) received a CXR and none of them had any abnormal findings, 48 (82.8%) had RSV/flu testing, no patients tested positive for RSV and only one patient tested positive for flu. Costs of CXR and RSV/flu testing for this cohort was $19,788. Conclusion The absence of positive CXRs in this patient population reinforces the current recommendations that CXR is not indicated. The low incidence of RSV/flu indicate that routine testing may not be necessary in this population especially outside of the flu season. Reduced testing could decrease overall costs to the healthcare system as well as radiation exposure to this population.
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20
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Dimopoulou D, Vourli S, Douros K, Pournaras S, Papaevangelou V. Use of point-of-care molecular tests reduces hospitalization and oseltamivir administration in children presenting with influenza-like illness. J Med Virol 2021; 93:3944-3948. [PMID: 32965697 DOI: 10.1002/jmv.26538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/15/2023]
Abstract
Influenza is associated with increased morbidity, healthcare costs, hospitalization rates, and mortality in children. Rapid immunochromatography assay (ICA), a test with low sensitivity, is often used as point-of-care (POC) test. Recently, the rapid syndromic molecular test FilmArray has become available. This observational study aims to evaluate whether the use of FilmArray would decrease the use of antivirals and hospitalization rates among children presenting to the emergency room (ER) with influenza-like illness (ILI) symptoms. Nasopharyngeal swabs were prospectively collected from children, aged 0-16 years, presenting with ILI at the ER of a tertiary hospital during the peak endemic period. Patients were allocated to be tested by either FilmArray or ICA. The use of antivirals and hospitalization rates were noted. Logistic regression models were used to investigate the impact of testing methods on decision-making. Overall, 80 children were included (mean age: 5 years). Admissions were more likely to occur if an ICA test was performed (OR, 3.16; 95% CI, 1.01-9.82; p = .046). Oseltamivir administration was more likely among children who had undergone the ICA test (OR, 4.67; 95% CI, 1.06-20.43; p = .041). The implementation of rapid molecular test had no impact on complementary diagnostic testing or antibacterial prescription. The use of FilmArray significantly reduced both hospitalization and oseltamivir administration in children. Further knowledge on the use of POC tests is required to improve current management of children presenting with ILI and decrease associated healthcare costs.
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Affiliation(s)
- Dimitra Dimopoulou
- Third Department of Pediatrics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Vourli
- Laboratory of Microbiology, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Douros
- Third Department of Pediatrics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Pournaras
- Laboratory of Microbiology, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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21
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Lee J, Song JU, Kim YH. Diagnostic Accuracy of the Quidel Sofia Rapid Influenza Fluorescent Immunoassay in Patients with Influenza-like Illness: A Systematic Review and Meta-analysis. Tuberc Respir Dis (Seoul) 2021; 84:226-236. [PMID: 33979987 PMCID: PMC8273023 DOI: 10.4046/trd.2021.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background Although the Quidel Sofia rapid influenza fluorescent immunoassay (FIA) is widely used to identify influenza A and B, the diagnostic accuracy of this test remains unclear. Thus, the objective of this study was to determine the diagnostic performance of this test compared to reverse transcriptase-polymerase chain reaction. Methods A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and a hierarchical summary receiver-operating characteristic curve (HSROC) of this test for identifying influenza A and B were determined using meta-analysis. A sensitivity subgroup analysis was performed to identify potential sources of heterogeneity within selected studies. Results We identified 17 studies involving 8,334 patients. Pooled sensitivity, specificity, and DOR of the Quidel Sofia rapid influenza FIA for identifying influenza A were 0.78 (95% confidence interval [CI], 0.71–0.83), 0.99 (95% CI, 0.98–0.99), and 251.26 (95% CI, 139.39–452.89), respectively. Pooled sensitivity, specificity, and DOR of this test for identifying influenza B were 0.72 (95% CI, 0.60–0.82), 0.98 (95% CI, 0.96–0.99), and 140.20 (95% CI, 55.92–351.54), respectively. The area under the HSROC for this test for identifying influenza A was similar to that for identifying influenza B. Age was considered a probable source of heterogeneity. Conclusion Pooled sensitivities of the Quidel Sofia rapid influenza FIA for identifying influenza A and B did not quite meet the target level (≥80%). Thus, caution is needed when interpreting data of this study due to substantial between-study heterogeneity.
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Affiliation(s)
- Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yee Hyung Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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22
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Borensztajn D, Zachariasse JM, Greber-Platzer S, Alves CF, Freitas P, Smit FJ, van der Lei J, Steyerberg EW, Maconochie I, Moll HA. Shortness of breath in children at the emergency department: Variability in management in Europe. PLoS One 2021; 16:e0251046. [PMID: 33951099 PMCID: PMC8099081 DOI: 10.1371/journal.pone.0251046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Our aim was to describe variability in resource use and hospitalization in children presenting with shortness of breath to different European Emergency Departments (EDs) and to explore possible explanations for variability. DESIGN The TrIAGE project, a prospective observational study based on electronic health record data. PATIENTS AND SETTING Consecutive paediatric emergency department visits for shortness of breath in five European hospitals in four countries (Austria, Netherlands, Portugal, United Kingdom) during a study period of 9-36 months (2012-2014). MAIN OUTCOME MEASURES We assessed diversity between EDs regarding resource use (diagnostic tests, therapy) and hospital admission using multivariable logistic regression analyses adjusting for potential confounding variables. RESULTS In total, 13,552 children were included. Of those, 7,379 were categorized as immediate/very urgent, ranging from 13-80% in the participating hospitals. Laboratory tests and X-rays were performed in 8-33% of the cases and 21-61% was treated with inhalation medication. Admission rates varied between 8-47% and PICU admission rates varied between 0.1-9%. Patient characteristics and markers of disease severity (age, sex, comorbidity, urgency, vital signs) could explain part of the observed variability in resource use and hospitalization. However, after adjusting for these characteristics, we still observed substantial variability between settings. CONCLUSION European EDs differ substantially regarding the resource use and hospitalization in children with shortness of breath, even when adjusting for patient characteristics. Possible explanations for this variability might be unmeasured patient characteristics such as underlying disease, differences in guideline use and adherence or different local practice patterns.
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Affiliation(s)
- Dorine Borensztajn
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Joany M. Zachariasse
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Susanne Greber-Platzer
- Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Claudio F. Alves
- Department of Paediatrics, Hospital Prof. Dr. Fernando da Fonseca, Lisbon, Portugal
| | - Paulo Freitas
- Intensive Care Unit, Hospital Prof. Dr. Fernando da Fonseca, Lisbon, Portugal
| | - Frank J. Smit
- Department of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ewout W. Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ian Maconochie
- Department of Paediatric Accident and Emergency, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Henriëtte A. Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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23
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Smith ER, Fry AM, Hicks LA, Fleming-Dutra KE, Flannery B, Ferdinands J, Rolfes MA, Martin ET, Monto AS, Zimmerman RK, Nowalk MP, Jackson ML, McLean HQ, Olson SC, Gaglani M, Patel MM. Reducing Antibiotic Use in Ambulatory Care Through Influenza Vaccination. Clin Infect Dis 2021; 71:e726-e734. [PMID: 32322875 DOI: 10.1093/cid/ciaa464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/20/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Improving appropriate antibiotic use is crucial for combating antibiotic resistance and unnecessary adverse drug reactions. Acute respiratory illness (ARI) commonly causes outpatient visits and accounts for ~41% of antibiotics used in the United States. We examined the influence of influenza vaccination on reducing antibiotic prescriptions among outpatients with ARI. METHODS We enrolled outpatients aged ≥6 months with ARI from 50-60 US clinics during 5 winters (2013-2018) and tested for influenza with RT-PCR; results were unavailable for clinical decision making and clinical influenza testing was infrequent. We collected antibiotic prescriptions and diagnosis codes for ARI syndromes. We calculated vaccine effectiveness (VE) by comparing vaccination odds among influenza-positive cases with test-negative controls. We estimated ARI visits and antibiotic prescriptions averted by influenza vaccination using estimates of VE, coverage, and prevalence of antibiotic prescriptions and influenza. RESULTS Among 37 487 ARI outpatients, 9659 (26%) were influenza positive. Overall, 36% of ARI and 26% of influenza-positive patients were prescribed antibiotics. The top 3 prevalent ARI syndromes included: viral upper respiratory tract infection (47%), pharyngitis (18%), and allergy or asthma (11%). Among patients testing positive for influenza, 77% did not receive an ICD-CM diagnostic code for influenza. Overall, VE against influenza-associated ARI was 35% (95% CI, 32-39%). Vaccination prevented 5.6% of all ARI syndromes, ranging from 2.8% (sinusitis) to 11% (clinical influenza). Influenza vaccination averted 1 in 25 (3.8%; 95% CI, 3.6-4.1%) antibiotic prescriptions among ARI outpatients during influenza seasons. CONCLUSIONS Vaccination and accurate influenza diagnosis may curb unnecessary antibiotic use and reduce the global threat of antibiotic resistance.
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Affiliation(s)
- Emily R Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Brendan Flannery
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jill Ferdinands
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa A Rolfes
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Scott C Olson
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University, Temple, Texas, USA
| | - Manish M Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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24
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Yadav S, Sharma NN, Akhtar J. Nucleic acid analysis on paper substrates (NAAPs): an innovative tool for Point of Care (POC) infectious disease diagnosis. Analyst 2021; 146:3422-3439. [PMID: 33904559 DOI: 10.1039/d1an00214g] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The cost-effective rapid diagnosis of infectious diseases is an essential and important factor for curing such diseases in the global public health care picture. Owing to poor infrastructure and lack of sanitation, these diseases have an extreme impact on remote and rural areas, especially in developing countries, and there are unresolved challenges. Molecular diagnosis, such as nucleic acid analysis, plays a key role in the significant treatment of numerous infectious diseases. Current molecular diagnostic assays require a sophisticated laboratory setup with expensive components. Molecular diagnosis on a microfluidic point-of-care (POC) platform is attractive to researchers for disease detection with proper prevention. Compared to various microfluidic substrate materials, paper-based POC technologies offer significant cost-effective solutions over high-cost clinical instruments to fill the gap between the needs of users and affordability. Low-cost paper-based microfluidic POC technologies provide portable and disposable diagnostic systems for multiple disease detection that may be extremely useful in remote areas. This article presents a critical review of paper-based microfluidic device technology which has become an imminent platform to adjust the current health scenario for the detection of diseases using different stages of nucleic acid analysis, such as extraction, amplification and detection of nucleic acid, with future perspectives for paper substrates.
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Affiliation(s)
- Supriya Yadav
- Department of Biosciences, Manipal University Jaipur, 303007, Rajasthan, India.
| | - Niti Nipun Sharma
- Department of Mechanical Engineering, Manipal University Jaipur, 303007, Rajasthan, India.
| | - Jamil Akhtar
- Department of Electronics & Communication Engineering, Manipal University Jaipur, 303007, Rajasthan, India.
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25
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Alter DN. Point-of-Care Testing for the Emergency Department Patient: Quantity and Quality of the Available Evidence. Arch Pathol Lab Med 2021; 145:308-319. [PMID: 33635952 DOI: 10.5858/arpa.2020-0495-ra] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Point-of-care test (POCT) instruments produce lab results with rapid turnaround times. Based on that fact, emergency department (ED) POCT requests are predicated on the belief that rapid test turnaround times lead to improved care, typically a decreased ED length of stay (LOS). OBJECTIVE.— To compile the available peer-reviewed data regarding use of POCT in the ED with an emphasis on ED-LOS. DATA SOURCES.— An English-language PubMed search using the following free text terms: ("EMERGENCY" AND "POINT OF CARE") NOT ULTRASOUND as well as "RAPID INFECTIOUS DISEASE TESTING." In addition, the PubMed "similar articles" functionality was used to identify related articles that were not identified on the initial search. CONCLUSIONS.— Seventy-four references were identified that studied POCT ED use to determine if they resulted in significant changes in ED processes, especially ED-LOS. They were divided into 3 groups: viral-influenza (n = 24), viral-respiratory not otherwise specified (n = 8), and nonviral (n = 42). The nonviral group was further divided into the following groups: chemistry, cardiac, bacterial/strep, C-reactive protein, D-dimer, drugs of abuse, lactate, and pregnancy. Across all groups there was a trend toward a significantly decreased ED-LOS; however, a number of studies showed no change, and a third group was not assessed for ED-LOS. For POCT to improve ED-LOS it has to be integrated into existing ED processes such that a rapid test result will allow the patient to have a shorter LOS, whether it is to discharge or admission.
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Affiliation(s)
- David N Alter
- From the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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26
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Liu Y, Zhan L, Qin Z, Sackrison J, Bischof JC. Ultrasensitive and Highly Specific Lateral Flow Assays for Point-of-Care Diagnosis. ACS NANO 2021; 15:3593-3611. [PMID: 33607867 DOI: 10.1021/acsnano.0c10035] [Citation(s) in RCA: 228] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Lateral flow assays (LFAs) are paper-based point-of-care (POC) diagnostic tools that are widely used because of their low cost, ease of use, and rapid format. Unfortunately, traditional commercial LFAs have significantly poorer sensitivities (μM) and specificities than standard laboratory tests (enzyme-linked immunosorbent assay, ELISA: pM-fM; polymerase chain reaction, PCR: aM), thus limiting their impact in disease control. In this Perspective, we review the evolving efforts to increase the sensitivity and specificity of LFAs. Recent work to improve the sensitivity through assay improvement includes optimization of the assay kinetics and signal amplification by either reader systems or additional reagents. Together, these efforts have produced LFAs with ELISA-level sensitivities (pM-fM). In addition, sample preamplification can be applied to both nucleic acids (direct amplification) and other analytes (indirect amplification) prior to LFA testing, which can lead to PCR-level (aM) sensitivity. However, these amplification strategies also increase the detection time and assay complexity, which inhibits the large-scale POC use of LFAs. Perspectives to achieve future rapid (<30 min), ultrasensitive (PCR-level), and "sample-to-answer" POC diagnostics are also provided. In the case of LFA specificity, recent research efforts have focused on high-affinity molecules and assay optimization to reduce nonspecific binding. Furthermore, novel highly specific molecules, such as CRISPR/Cas systems, can be integrated into diagnosis with LFAs to produce not only ultrasensitive but also highly specific POC diagnostics. In summary, with continuing improvements, LFAs may soon offer performance at the POC that is competitive with laboratory techniques while retaining a rapid format.
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Affiliation(s)
- Yilin Liu
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Li Zhan
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Zhenpeng Qin
- Department of Mechanical Engineering, University of Texas at Dallas, Richardson, Texas 75080 United States
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
- Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - James Sackrison
- 3984 Hunters Hill Way, Minnetonka, Minnesota 55345, United States
| | - John C Bischof
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
- Director, Institute of Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota 55455, United States
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27
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El Feghaly RE, Nolen JD, Lee BR, Abraham G, Nedved A, Hassan F, Selvarangan R. Impact of Rapid Influenza Molecular Testing on Management in Pediatric Acute Care Settings. J Pediatr 2021; 228:271-277.e1. [PMID: 32828881 DOI: 10.1016/j.jpeds.2020.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/01/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To measure the impact of rapid influenza real-time qualitative reverse transcriptase polymerase chain reaction (RT-PCR) on patient management in busy pediatric emergency department (ED) and urgent care clinic settings. STUDY DESIGN We developed a brief, elective survey that clinicians completed when an influenza RT-PCR order was placed in the ED or urgent care clinic between February 18, 2019, and March 13, 2019. We captured the clinical suspicion for influenza, intended management plans, and actual management plans once influenza RT-PCR results were available. RESULTS We evaluated 339 encounters, of which 164 (48.4%) had a positive influenza RT-PCR. Clinical suspicion for influenza was a nonsignificant predictor for influenza PT-PCR positivity (P = .126). After rapid influenza RT-PCR results were available, clinicians changed their original plans in 44.5% of influenza RT-PCR positive vs 92.6% of influenza RT-PCR negative cases (P < .0001). Change in plans for antiviral use was observed in 26% of influenza positive vs 77% of influenza negative cases (P < .0001). A total of 135 antiviral prescriptions were avoided in patients with negative influenza RT-PCR. CONCLUSIONS Implementation of a rapid and accurate influenza RT-PCR in the acute care setting is important to systematically diagnose influenza in children and improve outpatient management decisions, because clinical suspicion for influenza is inaccurate. A negative influenza RT-PCR decreases unnecessary antiviral use and has the potential for significant cost savings.
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Affiliation(s)
- Rana E El Feghaly
- Division of Infectious Diseases, Children's Mercy Kansas City, Kansas City, MO; University of Missouri Kansas City, Kansas City, MO
| | - John David Nolen
- University of Missouri Kansas City, Kansas City, MO; Division of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Brian R Lee
- University of Missouri Kansas City, Kansas City, MO; Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO
| | - George Abraham
- University of Missouri Kansas City, Kansas City, MO; Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Amanda Nedved
- University of Missouri Kansas City, Kansas City, MO; Division of Urgent Care, Children's Mercy Kansas City, Kansas City, MO
| | - Ferdaus Hassan
- University of Missouri Kansas City, Kansas City, MO; Division of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Rangaraj Selvarangan
- Division of Infectious Diseases, Children's Mercy Kansas City, Kansas City, MO; University of Missouri Kansas City, Kansas City, MO; Division of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO.
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Jacquier H, Péan de Ponfilly G, Chauvin A, Amarsy R, Benmansour H, Hoang-Nguyen DT, Lecorché E, Mesnil C, Mougari F, Munier AL, Salmona M, Berçot B, Le Goff J, Cambau E. Impact of a 24/7 Rapid Molecular Assay for Influenza Detection on the Prescription of Oseltamivir. Open Forum Infect Dis 2020; 7:ofaa374. [PMID: 32968690 PMCID: PMC7494179 DOI: 10.1093/ofid/ofaa374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/21/2020] [Indexed: 11/13/2022] Open
Abstract
We assessed the impact of a rapid molecular assay for influenza detection whether outsourced or performed onsite 24/7 in a University Hospital in Paris, France. Shorter median time-to-results (16.8 vs 2.3 hours, P < .05) and an increased rate of adequate prescription of oseltamivir (76.6% vs 95.3%, P < .05) were observed.
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Affiliation(s)
- Hervé Jacquier
- Laboratory of Microbiology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Université de Paris, IAME, UMR 1137, INSERM, Paris, France
| | - Gauthier Péan de Ponfilly
- Laboratory of Microbiology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Anthony Chauvin
- Emergency Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Rishma Amarsy
- Infection Control Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Hana Benmansour
- Laboratory of Microbiology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | | | - Emmanuel Lecorché
- Laboratory of Microbiology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Université de Paris, IAME, UMR 1137, INSERM, Paris, France
| | - Céline Mesnil
- Emergency Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Faiza Mougari
- Laboratory of Microbiology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Université de Paris, IAME, UMR 1137, INSERM, Paris, France
| | - Anne-Lise Munier
- Department of Infectious Diseases, Saint Louis-Lariboisiere-Fernand Widal University Hospital, APHP, Paris, France
| | - Maud Salmona
- Unit of Virology and Graft, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal University Hospital, APHP, Paris, France
| | - Béatrice Berçot
- Laboratory of Microbiology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jérôme Le Goff
- Unit of Virology and Graft, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal University Hospital, APHP, Paris, France.,Université de Paris, INSERM U976, team INSIGHT, Paris, France
| | - Emmanuelle Cambau
- Laboratory of Microbiology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Université de Paris, IAME, UMR 1137, INSERM, Paris, France
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29
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Jacob R, White B, McCaskill ME. Does location of rapid influenza diagnostic testing influence treatment time and ancillary testing in a paediatric emergency department? Emerg Med Australas 2020; 33:88-93. [PMID: 32808485 DOI: 10.1111/1742-6723.13591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Influenza causes a significant burden of disease. Our aim was to assess whether location of rapid influenza diagnostic testing (RIDT) for patients with influenza-like illness (ILI) has an impact on ED treatment time or ancillary testing. METHODS This was a retrospective observational study in a tertiary paediatric ED during 2017 influenza season. All patients with ILI were included. Some had RIDT performed (ED bedside or at the laboratory). Primary outcome measure was the correlation of RIDT location to treatment time compared to patients with ILI with no RIDT. Secondary outcome measures were the correlation of RIDT location to ancillary testing and treatment with antibiotics. RESULTS A total of 1451 patients with ILI were included. Eighty patients for whom RIDT was performed at the laboratory had a shorter treatment time in the ED when compared to the 215 patients for whom RIDT was performed bedside (2.8 and 3.4 h, respectively; P < 0.0001). However, treatment time was not statistically different when sub-analysed for admitted and discharged patients separately. Overall, patients with ILI and no RIDT had the shortest treatment time in the ED (1.7 h). There was no difference in ancillary testing and treatment with antibiotics between ILI patients for whom RIDT was performed bedside or at the laboratory regardless of admission. CONCLUSION Location of RIDT may not have a significant impact on treatment time, ancillary testing and treatment with antibiotics. When RIDT was not performed, patients had the shortest treatment time.
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Affiliation(s)
- Ron Jacob
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Paediatric Emergency Department, Ha'Emek Medical Centre, Afula, Israel
| | - Brent White
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Mary E McCaskill
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Papan C, Willersinn M, Weiß C, Karremann M, Schroten H, Tenenbaum T. Antibiotic utilization in hospitalized children under 2 years of age with influenza or respiratory syncytial virus infection - a comparative, retrospective analysis. BMC Infect Dis 2020; 20:606. [PMID: 32807104 PMCID: PMC7430130 DOI: 10.1186/s12879-020-05336-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Infections due to Respiratory Syncytial Virus (RSV) and Influenza virus (FLU) are leading causes of hospitalization in young children. Yet, there is little data on factors associated with antibiotic use in these patients. METHODS We conducted a retrospective, single-center study of all patients below 2 years of age hospitalized between 2014 and 2018. We compared children with RSV infection to children with FLU infection analyzing clinical characteristics and factors contributing to an increased rate of antimicrobial utilization. RESULTS RSV infection was diagnosed in 476/573 (83.1%), FLU in 95/573 (16.6%), and RSV-FLU-co-infection in 2/573 (0.3%) patients. Median age was lower for RSV compared to FLU (4 vs. 12 months; p < 0.0001). Children with RSV had longer hospitalization (5 vs. 4 days; p = 0.0023) and needed oxygen more frequently (314/476 vs. 23/95; p < 0.0001) than FLU patients. There was no significant difference in the overall antibiotic utilization between RSV and FLU patients (136/476 vs. 21/95; p = 0.2107). Logistic regression analyses revealed that septic appearance on admission (odds ratio [OR] 8.95, 95% confidence interval [CI] 1.5-54.1), acute otitis media (OR 4.5, 95% CI 2.1-9.4), a longer oxygen therapy (OR 1.40; 95% CI 1.13-1.74) and a higher C-reactive protein (CRP) (OR 1.7, 95% CI 1.5-2.0) were significantly associated with antibiotic use in both groups, but not age or pneumonia. CONCLUSIONS In our cohort, the rate of antibiotic utilization was comparable between RSV and FLU patients, while for both groups distinct clinical presentation and a high CRP value were associated with higher antibiotic use.
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Affiliation(s)
- Cihan Papan
- Pediatric Infectious Diseases, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg, Germany.
| | - Meike Willersinn
- Pediatric Infectious Diseases, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiß
- Institute of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Karremann
- Pediatric Infectious Diseases, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Horst Schroten
- Pediatric Infectious Diseases, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Tenenbaum
- Pediatric Infectious Diseases, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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31
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Lee JJ, Verbakel JY, Goyder CR, Ananthakumar T, Tan PS, Turner PJ, Hayward G, Van den Bruel A. The Clinical Utility of Point-of-Care Tests for Influenza in Ambulatory Care: A Systematic Review and Meta-analysis. Clin Infect Dis 2020; 69:24-33. [PMID: 30285232 PMCID: PMC6579962 DOI: 10.1093/cid/ciy837] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/03/2018] [Indexed: 11/25/2022] Open
Abstract
Background Point-of-care tests (POCTs) for influenza are diagnostically superior to clinical diagnosis, but their impact on patient outcomes is unclear. Methods A systematic review of influenza POCTs versus usual care in ambulatory care settings. Studies were identified by searching six databases and assessed using the Cochrane risk of bias tool. Estimates of risk ratios (RR), standardised mean differences, 95% confidence intervals and I2 were obtained by random effects meta-analyses. We explored heterogeneity with sensitivity analyses and meta-regression. Results 12,928 citations were screened. Seven randomized studies (n = 4,324) and six non-randomized studies (n = 4,774) were included. Most evidence came from paediatric emergency departments. Risk of bias was moderate in randomized studies and higher in non-randomized studies. In randomized trials, POCTs had no effect on admissions (RR 0.93, 95% CI 0.61–1.42, I2 = 34%), returning for care (RR 1.00 95% CI = 0.77–1.29, I2 = 7%), or antibiotic prescribing (RR 0.97, 95% CI 0.82–1.15, I2 = 70%), but increased prescribing of antivirals (RR 2.65, 95% CI 1.95–3.60; I2 = 0%). Further testing was reduced for full blood counts (FBC) (RR 0.80, 95% CI 0.69–0.92 I2 = 0%), blood cultures (RR 0.82, 95% CI 0.68–0.99; I2 = 0%) and chest radiography (RR 0.81, 95% CI 0.68–0.96; I2 = 32%), but not urinalysis (RR 0.91, 95% CI 0.78–w1.07; I2 = 20%). Time in the emergency department was not changed. Fewer non-randomized studies reported these outcomes, with some findings reversed or attenuated (fewer antibiotic prescriptions and less urinalysis in tested patients). Conclusions Point-of-care testing for influenza influences prescribing and testing decisions, particularly for children in emergency departments. Observational evidence shows challenges for real-world implementation.
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Affiliation(s)
- Joseph Jonathan Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Jan Y Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom.,Academic Center for General Practice, Katholieke Universiteit Leuven, Belgium
| | - Clare Rosemary Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Thanusha Ananthakumar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Pui San Tan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Phillip James Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Ann Van den Bruel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom.,Academic Center for General Practice, Katholieke Universiteit Leuven, Belgium
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Clinical evaluation of fully automated molecular diagnostic system "Simprova" for influenza virus, respiratory syncytial virus, and human metapneumovirus. Sci Rep 2020; 10:13496. [PMID: 32782312 PMCID: PMC7419501 DOI: 10.1038/s41598-020-70090-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Influenza virus, respiratory syncytial virus, and human metapneumovirus commonly cause acute upper and lower respiratory tract infections, especially in children and the elderly. Although rapid antigen detection tests for detecting these infections have been introduced recently, these are less sensitive than nucleic acid amplification tests. More recently, highly sensitive point-of-care testings (POCTs) have been developed based on nucleic acid amplification tests, which are easy to use in clinical settings. In this study, loop-mediated isothermal amplification (LAMP)-based POCT “Simprova” to detect influenza A and B viruses, respiratory syncytial virus, and human metapneumovirus was developed. Simprova system is fully automated and does not require skilled personnel. In addition, positive results can be achieved faster than with PCR. In this study, the accuracy of the POCT was retrospectively analyzed using 241 frozen stocked specimens. Additionally, the usability of the Simprova at clinical sites was assessed in a prospective clinical study using 380 clinical specimens and compared to those of real-time PCR and rapid antigen detection test. The novel LAMP-based POCT demonstrated high sensitivity and specificity in characterizing clinical specimens from patients with influenza-like illnesses. The Simprova is a powerful tool for early diagnosis of respiratory viral infections in point-of-care settings.
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Iwasaki T, Hifumi T, Hayashi K, Otani N, Ishimatsu S. Rapid influenza diagnostic test at triage can decrease emergency department length of stay. J Am Coll Emerg Physicians Open 2020; 1:494-501. [PMID: 33000076 PMCID: PMC7493520 DOI: 10.1002/emp2.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Even if performing rapid influenza diagnostic tests test will not change clinical decision making, we sometimes perform at triage to reduce length of stay in Japan. Whether performing rapid influenza diagnostic tests at triage may shorten emergency department (ED) length of stay (LOS) is remains unclear. We aimed to determine the utility of rapid influenza diagnostic tests at triage in shortening ED length of stay LOS. METHODS We retrospectively reviewed medical records of patients discharged from our ED after receiving results from rapid influenza diagnostic tests during the influenza season from December, 2013 to March, 2019. Eligibility criteria were a walk-in visit, age ≥15 years, triage performed, rapid influenza diagnostic test administered, and no admission. The triage group received rapid influenza diagnostic tests at triage. The after-examination group received their tests only after examination by a doctor. The primary outcome was ED LOS after propensity score matching to adjust for several covariates. RESULTS Of 2,768 eligible patients, 2,554 patients were enrolled in the triage group (n = 363) or after examination group (n = 2,191). There were 329 matched pairs after propensity score matching. Median ED LOS was significantly shorter in the triage group than in the after-examination group after propensity score matching (81 min (interquartile range [IQR] 60 to 111) vs 106 min (IQR 80-142); median difference 24 min (95% confidence interval 17-30)). CONCLUSIONS Performing rapid influenza diagnostic tests at triage was associated with shorter ED LOS during the influenza season.
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Affiliation(s)
- Tsutomu Iwasaki
- Emergency and Critical Care medicine St. Luke's International Hospital Tokyo Japan
| | - Toru Hifumi
- Emergency and Critical Care medicine St. Luke's International Hospital Tokyo Japan
| | - Kuniyoshi Hayashi
- Graduate School of Public Health St. Luke's International University Tokyo Japan
| | - Norio Otani
- Emergency and Critical Care medicine St. Luke's International Hospital Tokyo Japan
| | - Shinichi Ishimatsu
- Emergency and Critical Care medicine St. Luke's International Hospital Tokyo Japan
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Abstract
BACKGROUND Influenza A viruses are conventionally thought to cause more severe illnesses than B viruses, but few studies with long observation periods have compared the clinical severity of A and B infections in hospitalized children. METHODS We analyzed the clinical presentation, outcomes and management of all children <16 years of age admitted to Turku University Hospital, Finland, with virologically confirmed influenza A or B infection during the 14-year period of 1 July 2004 to 30 June 2018. All comparisons between influenza A and B were performed both within predefined age groups (0-2, 3-9 and 10-15 years) and in all age groups combined. RESULTS Among 391 children hospitalized with influenza A or B infection, influenza A was diagnosed in 279 (71.4%) and influenza B in 112 (28.6%) children. Overall, there were no significant differences in any clinical features or outcomes, management, treatment at intensive care unit or length of stay between children with influenza A and B, whether analyzed by age group or among all children. As indicators of the most severe clinical presentations, blood cultures were obtained from 101 (36.2%) children with influenza A and 39 (34.8%) with influenza B (P = 0.80), and lumbar puncture was performed to 16 (5.7%) children with influenza A and 11 (9.8%) children with influenza B (P = 0.15). CONCLUSIONS The clinical severity of influenza A and B infections is similar in children. For optimal protection against severe influenza illnesses, the use of quadrivalent vaccines containing both lineages of B viruses seems warranted in children.
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Nelson PP, Rath BA, Fragkou PC, Antalis E, Tsiodras S, Skevaki C. Current and Future Point-of-Care Tests for Emerging and New Respiratory Viruses and Future Perspectives. Front Cell Infect Microbiol 2020; 10:181. [PMID: 32411619 PMCID: PMC7202255 DOI: 10.3389/fcimb.2020.00181] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/06/2020] [Indexed: 12/20/2022] Open
Abstract
The availability of pathogen-specific treatment options for respiratory tract infections (RTIs) increased the need for rapid diagnostic tests. Besides, retrospective studies, improved lab-based detection methods and the intensified search for new viruses since the beginning of the twenty-first century led to the discovery of several novel respiratory viruses. Among them are human bocavirus (HBoV), human coronaviruses (HCoV-HKU1, -NL63), human metapneumovirus (HMPV), rhinovirus type C (RV-C), and human polyomaviruses (KIPyV, WUPyV). Additionally, new viruses like SARS coronavirus (SARS-CoV), MERS coronavirus (MERS-CoV), novel strains of influenza virus A and B, and (most recently) SARS coronavirus 2 (SARS-CoV-2) have emerged. Although clinical presentation may be similar among different viruses, associated symptoms may range from a mild cold to a severe respiratory illness, and thus require a fast and reliable diagnosis. The increasing number of commercially available rapid point-of-care tests (POCTs) for respiratory viruses illustrates both the need for this kind of tests but also the problem, i.e., that the majority of such assays has significant limitations. In this review, we summarize recently published characteristics of POCTs and discuss their implications for the treatment of RTIs. The second key aspect of this work is a description of new and innovative diagnostic techniques, ranging from biosensors to novel portable and current lab-based nucleic acid amplification methods with the potential future use in point-of-care settings. While prototypes for some methods already exist, other ideas are still experimental, but all of them give an outlook of what can be expected as the next generation of POCTs.
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Affiliation(s)
- Philipp P Nelson
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL) Marburg, Marburg, Germany
| | - Barbara A Rath
- Vienna Vaccine Safety Initiative - Pediatric Infectious Diseases and Vaccines, Berlin, Germany.,UMR Chrono-Environnement, Université Bourgogne Franche-Comté, Besançon, France.,ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
| | - Paraskevi C Fragkou
- ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland.,4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Antalis
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland.,4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL) Marburg, Marburg, Germany.,ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
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Escovedo C, Bell D, Cheng E, Garner O, Ziman A, Vangala S, Gounder P, Lerner C. Noninterruptive Clinical Decision Support Decreases Ordering of Respiratory Viral Panels during Influenza Season. Appl Clin Inform 2020; 11:315-322. [PMID: 32349143 DOI: 10.1055/s-0040-1709507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE A growing body of evidence suggests that testing for influenza virus alone is more appropriate than multiplex respiratory viral panel (RVP) testing for general populations of patients with respiratory tract infections. We aimed to decrease the proportion of RVPs out of total respiratory viral testing ordered during influenza season. METHODS We implemented two consecutive interventions: reflex testing for RVPs only after a negative influenza test, and noninterruptive clinical decision support (CDS) including modifications of the computerized physician order entry search behavior and cost display. We conducted an interrupted time series of RVPs and influenza polymerase chain reaction tests pre- and postintervention, and performed a mixed-effects logistic regression analysis with a primary outcome of proportion of RVPs out of total respiratory viral tests. The primary predictor was the intervention period, and covariates included the provider, clinical setting, associated diagnoses, and influenza incidence. RESULTS From March 2013 to April 2019, there were 24,294 RVPs and 26,012 influenza tests (n = 50,306). Odds of ordering an RVP decreased during the reflex testing period (odds ratio: 0.432, 95% confidence interval: 0.397-0.469), and decreased more dramatically during the noninterruptive CDS period (odds ratio: 0.291, 95% confidence interval: 0.259-0.327). DISCUSSION The odds of ordering an RVP were 71% less with the noninterruptive CDS intervention, which projected 4,773 fewer RVPs compared with baseline. Assuming a cost equal to Medicare reimbursement rates for RVPs and influenza tests, this would generate an estimated averted cost of $1,259,474 per year. CONCLUSION Noninterruptive CDS interventions are effective in reducing unnecessary and expensive testing, and avoid typical pitfalls such as alert fatigue.
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Affiliation(s)
- Cameron Escovedo
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
| | - Douglas Bell
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Eric Cheng
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, United States
| | - Omai Garner
- Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Alyssa Ziman
- Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Sitaram Vangala
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, California, United States
| | - Prabhu Gounder
- Acute Communicable Disease Control, County of Los Angeles Public Health, Los Angeles, California, United States
| | - Carlos Lerner
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
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AACC Guidance Document on Management of Point-of-Care Testing. J Appl Lab Med 2020; 5:762-787. [DOI: 10.1093/jalm/jfaa059] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 02/01/2023]
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38
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Quirós-González V, Rodríguez-Pérez P, Haro-Pérez AM, Jiménez-Rodríguez MM, Maderuelo-Fernández JÁ, Eiros JM. Real-time surveillance systems: Applicability for the control of influenza in acute care. Influenza Other Respir Viruses 2020; 14:331-339. [PMID: 32124557 PMCID: PMC7182607 DOI: 10.1111/irv.12720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 01/25/2023] Open
Abstract
Background The high morbidity and mortality caused by influenza viruses translate into a great impact on specialized health care. Apart from the annual vaccination, the relevance of other measures to prevent and control this infection is unknown. The objective of our research was to determine the importance of a real‐time surveillance system to establish early extended transmission precautions. Methods Quasi‐experimental before‐and‐after study comparing the influenza cases detected in hospitalized adults during the 2016/2017 season (264 patients) with those detected after the implementation of a real‐time surveillance system in the 2017/2018 season (519 patients). The improvements included early microbiological diagnosis, immediate communication of results, constant updating of patient information, coordination among professionals, periodic surveillance of the adequacy of preventive measures, and greater control of roommates. The effectiveness of the intervention was determined from the nosocomial infection rate in each season. Results After the real‐time surveillance system for influenza was implemented, patients with early microbiological diagnosis and immediate isolation increased significantly (13.7% vs 68.2%; P < .001). In addition, nosocomial infections decreased from 17% to 9.2% (P = .001) and overall hospital stay was significantly reduced. Assuming that the entire effect was due to the intervention, the absolute risk reduction was 7.8% and number needed to treat was 12.8. Conclusion The results in our study reveal the impact of nosocomial transmission of influenza virus in a tertiary hospital and highlight the need to supplement traditional strategies with novel methodologies such as modern surveillance systems based on early diagnosis, close case monitoring, and coordination among professionals.
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Affiliation(s)
- Víctor Quirós-González
- Department of Preventive Medicine, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Paz Rodríguez-Pérez
- Department of Preventive Medicine, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Ana Mª Haro-Pérez
- Department of Preventive Medicine, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Mª Mar Jiménez-Rodríguez
- Department of Preventive Medicine, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - José Ángel Maderuelo-Fernández
- Primary Health Care Research Unit of Salamanca, APISAL, Institute of Biomedical Research of Salamanca (IBSAL), Health Service of Castilla y León (SACYL), Salamanca, Spain
| | - José Mª Eiros
- Department of Clinical Microbiology, University Hospital Rio Hortega, Valladolid, Spain
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The Effect of Early Knowledge of Respiratory Syncytial Virus Positivity on Medical Decision Making and Throughput Time Within the Pediatric Emergency Department. Pediatr Emerg Care 2020; 36:134-137. [PMID: 29298247 DOI: 10.1097/pec.0000000000001361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether early knowledge of respiratory syncytial virus (RSV) positivity by rapid triage-based testing protocol improved emergency department (ED) throughput time and decreased ED ancillary testing and antibiotic administration. METHODS A retrospective cohort study was performed of ED patients aged 2 to 12 months, presenting November 1 to March 31 for the years 2008-2013. Included patients presented with fever and upper respiratory tract symptoms. Patients were excluded if they tested positive for influenza, had chronic underlying medical problems, or were admitted or transferred from an outside facility or if no RSV result was documented. The study group was compared with infants who tested negative for RSV by the triage-based protocol and were diagnosed as having (1) bronchiolitis and (2) a viral illness. RESULTS Of 899 patients tested for RSV within triage, the study included 713 (79%); 231 (35.3%) tested positive for RSV. When comparing children diagnosed as having bronchiolitis, there was no statistically significant difference between RSV positive and negative in ED throughput time, ED administered antibiotics, or chest radiographs, urine analyses, blood cultures, or lumbar punctures obtained. When comparing children diagnosed as having a viral illness, RSV-positive patients had less chest radiographs, urine analysis, and blood cultures performed. CONCLUSIONS Identifying the virus responsible for bronchiolitis through a triage-based protocol does not decrease ED throughput time, antibiotic administration, or chest radiographs, urine analysis, or blood cultures obtained. In infants presenting with upper respiratory tract symptoms and fever, knowing RSV infectivity through a triage-based protocol does significantly decrease chest radiographs, urine analysis, and blood cultures obtained.
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Kadatz M, Payne M, Kiaii M, Romney MG, Karakas L, Lawson T, Marchuk S, Gill J, Lowe CF. Utility of Rapid Influenza Molecular Testing in an Outpatient Hemodialysis Unit: A Prospective Cohort Study. Can J Kidney Health Dis 2020; 7:2054358120907816. [PMID: 32153798 PMCID: PMC7045293 DOI: 10.1177/2054358120907816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/19/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Early initiation of antiviral therapy for individuals at risk for severe influenza infection is important for improving patient outcomes. Current guidelines recommend empiric antiviral therapy for patients with end-stage kidney disease presenting with suspected influenza infection. Rapid molecular influenza assays may reduce diagnostic uncertainty and improve patient outcomes by providing faster diagnostics compared to traditional batched polymerase chain reaction (PCR) testing. Objective: To determine the utility of implementing a rapid influenza PCR assay compared to the standard of care in a hemodialysis unit. Design: This is a prospective cohort study. Setting: A hospital-based dialysis unit in a tertiary care hospital. Patients: Adult patients with end-stage kidney disease on intermittent hemodialysis. Measurements: Patient characteristics, influenza PCR swab results, antibiotic prescriptions, antiviral prescriptions, emergency room visits and hospitalizations. Methods: From November 1, 2017 to March 31, 2018, we assigned samples collected from a single center, hemodialysis unit to be processed using a rapid influenza PCR (cobas® Influenza A/B & respiratory syncytial virus assay) or the standard of care (in-house developed multiplex PCR). Samples were assigned to the rapid PCR if the patient received dialysis treatment in the morning dialysis shift, while the remainder were processed as per standard of care. Study outcomes included the time from collection to result of nasopharyngeal swab, prescription of influenza antiviral therapy, time to receiving prescription, and the need for emergency department visit or hospitalization within 2 weeks of presentation. Results: During the study period, 44 patients were assessed (14 with the rapid PCR and 30 with the standard of care assay). Compared to conventional testing, the time to result was shorter using rapid PCR compared to conventional testing (2.3 vs 22.6 hours, P < .0001). Individuals who were tested using the rapid PCR had a tendency to shorter time to receiving antiviral prescriptions (0.7 days vs 2.1 days, P = .11), and fewer emergency department visits (7.1% vs 30%, P = .13) but no difference in hospitalizations (14.3% vs 30%, P = .46) within 2 weeks of testing. Limitations: This is a single center non-randomized study with a relatively small sample size. Patients who were tested using the standard of care assay experienced a delay in the prescription of antiviral therapy which deviates from recommended clinical practice. Conclusions: Rapid influenza molecular testing in the hemodialysis unit was associated with a shorter time to a reportable result and with a tendency to reduced time to prescription of antiviral therapy. Rapid molecular testing should be compared with standard of care (empiric therapy) in terms of economic costs, adverse events, and influenza-related outcomes.
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Affiliation(s)
- Matthew Kadatz
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Michael Payne
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada.,Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada
| | - Mercedeh Kiaii
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Marc G Romney
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada.,Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada
| | - Loretta Karakas
- Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada
| | - Tanya Lawson
- Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada
| | - Stan Marchuk
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - John Gill
- Division of Nephrology, The University of British Columbia, Vancouver, Canada.,Center for Health Evaluation and Outcomes Sciences, The University of British Columbia, Vancouver, Canada
| | - Christopher F Lowe
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada.,Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada
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Railey AF, Lankester F, Lembo T, Reeve R, Shirima G, Marsh TL. Enhancing livestock vaccination decision-making through rapid diagnostic testing. WORLD DEVELOPMENT PERSPECTIVES 2019; 16:100144. [PMID: 32201751 PMCID: PMC7067263 DOI: 10.1016/j.wdp.2019.100144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
•Compared to vaccination, the collective approach to diagnostic testing presents a low-fixed cost.•Existing household livestock-health behaviors increase the likelihood for uptake of preventative health practices.•Initial evidence to support household investments in livestock preventative health over therapeutic treatments.
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Affiliation(s)
- Ashley F. Railey
- Paul G. Allen School for Global Animal Health, Washington State University, USA
- Corresponding author.
| | - Felix Lankester
- Paul G. Allen School for Global Animal Health, Washington State University, USA
| | - Tiziana Lembo
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - Richard Reeve
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - Gabriel Shirima
- Paul G. Allen School for Global Animal Health, Washington State University, USA
- Nelson Mandela African Institution of Science and Technology, Tanzania
| | - Thomas L. Marsh
- Paul G. Allen School for Global Animal Health, Washington State University, USA
- School of Economic Sciences, Washington State University, USA
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Testing for Urinary Tract Infection in the Influenza/Respiratory Syncytial Virus-Positive Febrile Infant Aged 2 to 12 Months. Pediatr Emerg Care 2019; 35:666-670. [PMID: 28277411 DOI: 10.1097/pec.0000000000001073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Infants 12 months or younger with influenza and respiratory syncytial virus (RSV) commonly present to the emergency department (ED) with fever. Previous publications have recommended that these patients have a urinalysis and urine culture performed. We aimed to assess the prevalence of urinary tract infection (UTI) in febrile RSV/influenza positive infants aged 2 to 12 months presenting to the ED. We also examined whether the 2011 American Academy of Pediatrics (AAP) UTI clinical practice guidelines could be used to identify patients at lower risk of UTI. METHODS This was a retrospective chart review examining all infants aged 2 to 12 months with a documented fever of higher than 38°C who presented to our ED from 2009 to 2013 and tested positive for influenza and/or RSV. RESULTS One thousand seven hundred twenty-four patients were found to meet our inclusion criteria. Of these, 98 were excluded because of known urinary tract anomaly or systemic antibiotic use in the 24 hours preceding evaluation. Of those patients remaining, 10 (0.62%) of 1626 had positive urine cultures (95% confidence interval, 0.3%-1.1%), and 8 (0.49%) of 1626 (95% confidence interval, 0.2%-0.97%) had positive urine cultures with positive urinalyses as defined in the 2011 AAP UTI clinical practice guidelines. All subjects with positive urine cultures as defined by the AAP had risk factors for UTI that placed their risk for UTI above 1%. CONCLUSIONS Our population of 2- to 12-month-old febrile infants with positive influenza/RSV testing, who did not have risk factors to make their risk of UTI higher than 1%, may not have required evaluation with urinalysis or urine culture.
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Saarela E, Tapiainen T, Kauppila J, Pokka T, Uhari M, Kauma H, Renko M. Impact of multiplex respiratory virus testing on antimicrobial consumption in adults in acute care: a randomized clinical trial. Clin Microbiol Infect 2019; 26:506-511. [PMID: 31574339 PMCID: PMC7128925 DOI: 10.1016/j.cmi.2019.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/14/2019] [Accepted: 09/15/2019] [Indexed: 12/24/2022]
Abstract
Objectives Inappropriate use of antibiotics is associated with development of antimicrobial resistance. In respiratory infections it is often difficult to differentiate between viral and bacterial infections, and empirical treatment is common. Enhanced viral testing is expected to clarify clinical decision-making and reduce the prescription of antibacterial agents, but the impact of such information on patient care is unclear. Methods We conducted a (1:1) randomized controlled clinical trial involving 998 adults with respiratory symptoms, fever, chest pain or poor general condition in the emergency unit of a tertiary hospital. Multiplex PCR results for 496 patients were available in 24 hours (intervention group) and those for the remaining 502 patients were available in 7 days (control group). Our primary outcome measures were the duration of hospitalization and the consumption of antibiotics within 30 days of enrolment. Results In all, 841 of 998 (84%) patients had respiratory symptoms at study entry. A respiratory virus was detected in 175 (17.5%). The mean duration of hospitalization was 4.2 days (SD 5.4) in the intervention group and 4.1 days (SD 4.9) in the control group (difference 0.1, 95% CI –0.5 to 0.6, p 0.810). The mean days on antibiotics were 11.3 days (SD 12.6) in the intervention group and 10.4 days (SD 11.4) in the control group (difference 0.9, 95% CI –0.6 to 2.4, p 0.235). Conclusions Multiplex PCR testing for respiratory viruses with results available within 24 hours did not reduce the consumption of bacterial antibiotics or the length of hospital stay in adults presenting with respiratory symptoms, fever, chest pain or reduced general condition in acute care.
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Affiliation(s)
- E Saarela
- Research Unit of Internal Medicine, Oulu University Hospital and University of Oulu, Finland.
| | - T Tapiainen
- PEDEGO Research Unit, University of Oulu, Finland; Department of Pediatrics and Adolescence, Oulu University Hospital, Finland
| | - J Kauppila
- Seinäjoki Central Hospital, Seinäjoki, Finland; Nordlab, Oulu, Finland
| | - T Pokka
- PEDEGO Research Unit, University of Oulu, Finland; Department of Pediatrics and Adolescence, Oulu University Hospital, Finland
| | - M Uhari
- PEDEGO Research Unit, University of Oulu, Finland; Department of Pediatrics and Adolescence, Oulu University Hospital, Finland
| | - H Kauma
- Research Unit of Internal Medicine, Oulu University Hospital and University of Oulu, Finland
| | - M Renko
- PEDEGO Research Unit, University of Oulu, Finland; Department of Pediatrics and Adolescence, Oulu University Hospital, Finland
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Abstract
The timely and accurate diagnosis of respiratory virus infections has the potential to optimize downstream (posttesting) use of limited health care resources, including antibiotics, antivirals, ancillary testing, and inpatient and emergency department beds. Cost-effective algorithms for respiratory virus testing must take into consideration numerous factors, including which patients should be tested, what testing should be performed (for example, antigen testing versus reverse transcription-PCR testing or influenza A/B testing versus testing with a comprehensive respiratory virus panel), and the turnaround time necessary to achieve the desired posttesting outcomes. Despite the clinical impact of respiratory virus infections, the cost-effectiveness of respiratory virus testing is incompletely understood. In this article, we review the literature pertaining to the cost-effectiveness of respiratory virus testing in pediatric and adult patient populations, in emergency department, outpatient, and inpatient clinical settings. Furthermore, we consider the cost-effectiveness of a variety of testing methods, including rapid antigen tests, direct fluorescent antibody assays, and nucleic acid amplification tests.
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Martinot M, Greigert V, Gravier S, Klein S, Eyriey M, Pachart A, Kaiser JD, Zadeh MM, De Briel D, Gottwalles Y, Thibaud E. Positive Impact of a Point-of-Care Molecular Influenza Test in the Emergency Department During the 2017-2018 Seasonal Influenza Epidemic. Open Forum Infect Dis 2019; 6:5541691. [PMID: 31363768 PMCID: PMC6667710 DOI: 10.1093/ofid/ofz312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/26/2019] [Indexed: 01/23/2023] Open
Abstract
During the 2017-2018 flu epidemic, the point-of-care Alere-i (n = 72) and reverse transcription polymerase chain reaction (n = 106) tests were compared. Patients in the point-of-care group were administered oseltamivir significantly more rapidly (9 hours vs 23 hours), they spent less time in the emergency department, and they had lower rates of antibiotic administration and hospitalization.
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Affiliation(s)
- Martin Martinot
- Infectious and Tropical Diseases, Department Medecine E, Hôpitaux Civils de Colmar, Colmar, France
| | - Valentin Greigert
- Infectious and Tropical Diseases, Department Medecine E, Hôpitaux Civils de Colmar, Colmar, France.,Parasitology Department, Strasbourg University, Strasbourg, France
| | - Simon Gravier
- Infectious and Tropical Diseases, Department Medecine E, Hôpitaux Civils de Colmar, Colmar, France
| | - Stephane Klein
- Infectious and Tropical Diseases, Department Medecine E, Hôpitaux Civils de Colmar, Colmar, France
| | - Magali Eyriey
- Clinical Research Department Hôpitaux Civils de Colmar, Colmar, France
| | - Anne Pachart
- Clinical Research Department Hôpitaux Civils de Colmar, Colmar, France
| | | | - Mahsa Mohseni Zadeh
- Infectious and Tropical Diseases, Department Medecine E, Hôpitaux Civils de Colmar, Colmar, France
| | | | | | - Eric Thibaud
- Emergency Department, Hôpitaux Civils de Colmar, Colmar, France
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Diel R, Nienhaus A. Cost-Benefit Analysis of Real-Time Influenza Testing for Patients in German Emergency Rooms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132368. [PMID: 31277347 PMCID: PMC6651271 DOI: 10.3390/ijerph16132368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 12/24/2022]
Abstract
Background: Seasonal influenza causes significant morbidity worldwide and has a substantial economic impact on the healthcare system. Objective: To assess the cost–benefit relation of implementing a real-time influenza test in emergency rooms (ER) of German hospitals. Methods: A deterministic decision-analytic model was developed simulating the incremental costs of using the Solana® Influenza A+B test, compared to those of using conventional clinical judgement alone to confirm or exclude influenza in adult ILI (influenza-like illness) patients, in German ER, prior to hospitalization. Direct costs were evaluated from the hospital perspective, considering resource use directly related to influenza testing and treatment, as well as indirect costs incurred by nosocomial influenza transmission. Results: Through base-case analysis and assuming an influenza prevalence of 42.6%, real-time testing with Solana® reduced average costs of hospitalized ILI patients by €132.61, per tested patient. Moreover, the Solana® saved €6.9 per tested patient in favor of the hospital. In probabilistic sensitivity analysis, under all reasonable assumptions, implementing the Solana® saved on average €144.13 as compared to applying the clinical-judgement-only strategy, thus, it was found to be constantly less expensive. Conclusions: Using highly sensitive and specific real-time influenza tests in ILI patients at German ER might significantly reduce hospital expenditures
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), 24015 Kiel, Germany.
- Lung Clinic Grosshansdorf, Germany. Airway Disease Center North (ARCN), German Center for Lung Research (DZL), 22949 Großhansdorf, Germany.
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany.
| | - Albert Nienhaus
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
- Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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The impact of incorporating early rapid influenza diagnosis on hospital occupancy and hospital acquired influenza. Infect Control Hosp Epidemiol 2019; 40:897-903. [PMID: 31190679 DOI: 10.1017/ice.2019.159] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the impact of incorporating early rapid influenza diagnosis on antimicrobial usage, nosocomial influenza transmission, length of stay, and occupancy rates among hospitalized patients. SETTING A 1,100 bed tertiary-care hospital in southern Israel. METHODS We implemented early rapid detection of influenza with immediate communication of results. Using Orion methods, we compared the 2017-2018 influenza season to the prior season in our hospital and to the 2017-2018 occupancy rates at other Israeli hospitals. RESULTS During the intervention season, 5,006 patients were admitted; 1,824 were tested for influenza, of whom 437 (23.9%) were positive. In the previous season, 4,825 patients were admitted; 1,225 were tested and 288 (23.5%) were positive. Time from admission to test report decreased from 35.5 to 18.4 hours (P < .001). Early discharge rates significantly increased, from 21.5% to 41.6% at 36 hours, from 37.2% to 54.5% at 48 hours, and from 66% to 73.2% at 72 hours. No increase in repeat ER visits, readmission, or mortality rates was observed. Hospital occupancy decreased by 10% compared to the previous year and was 26% lower than the national rate. Hospital-acquired influenza cases were reduced from 37 (11.4%) to 12 (2.7%) (P < .001). Antibiotic usage was reduced both before and after notification of test results by 16% and 12%, respectively. CONCLUSIONS Implementing this intervention led to earlier discharge of patients, lower occupancy in medical wards, reduced antibiotic administration, and fewer hospital-acquired influenza events. This strategy is useful for optimizing hospital resources, and its implementation should be considered for upcoming influenza seasons.
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Impact of Rapid On-demand Molecular Diagnosis of Pediatric Seasonal Influenza on Laboratory Workflow and Testing Costs: A Retrospective Study. Pediatr Infect Dis J 2019; 38:559-563. [PMID: 31117115 DOI: 10.1097/inf.0000000000002224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seasonal influenza imposes a considerable burden worldwide. We aimed to evaluate impact of rapid pediatric seasonal influenza diagnosis on laboratory workflow and cost using a rapid antigen detection-based test combined with either a reverse transcriptase polymerase chain reaction (RT-PCR) or the Alere i Influenza A and B (Alere i) assay for confirmation of negative results as well as single Alere i testing on nasopharyngeal aspirates. A secondary objective was assessing performance of Alere i against RT-PCR. METHODS Effects of implementing the 3 diagnostic algorithms were assessed in the Emergency Department of Hospital Sant Joan de Déu (Barcelona, Spain) across the 2014-2015, 2015-2016 and 2016-2017 influenza seasons. Alere i performance against RT-PCR was determined during the 2015-2016 epidemic period. RESULTS Median time to result decreased when using Alere i as a confirmatory test of previous antigen detection and RT-PCR results or alone (9.7vs. 3.5/2.0 and 0.7 hours, P < 0.001) along with mean testing costs (&OV0556;87.3 vs. &OV0556;38.2 and &OV0556;25.0, P < 0.001). Results available before patient discharge from the emergency department increased from 42.7% for sequential testing by antigen detection and RT-PCR to 80.0% when Alere i was utilized as a stand-alone test. Alere i sensitivity and specificity values were 96.6% (95% confidence interval: 82.8%-99.4%) and 94.4% (95% confidence interval: 86.6%-97.8%), respectively. CONCLUSIONS Rapid Alere i testing facilitated efficient laboratory workflow near the patient during influenza epidemics while contributing cost savings when compared with serial testing by antigen and RT-PCR assays.
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Rapid testing for respiratory viruses: Impact on antibiotic use and time to patient discharge. Infect Dis Health 2019; 24:147-151. [PMID: 31160245 DOI: 10.1016/j.idh.2019.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Influenza-like illness is often caused by respiratory viral infections, and is a frequent cause of presentation to hospital. Rapid diagnostics for respiratory viruses, with turnaround times of less than sixty minutes, are increasingly available. Early physician knowledge of positive respiratory virus tests has previously been shown to impact patient care in a paediatric population but hasn't been evaluated in adults. METHODS Rapid testing for the respiratory viruses Influenza A, Influenza B and respiratory syncytial virus (RSV) was introduced in our institution in 2018. This reduced turnaround time for tests from more than 24 h, to 1-10 h depending on time of day. A retrospective cohort study was performed on patients presenting with influenza-like illness, in whom a nasopharyngeal swab for respiratory viruses was requested. Data was collected before and after the introduction of the rapid assay. Outcomes included antibiotic use (less or more than 24 h) and length of hospital stay (less or more than 24 h). RESULTS In all patients who tested positive for a respiratory virus, there was an association between rapid testing and less antibiotic use. This was largely driven by paediatric cases; there was no change in prescribing for adult patients. There was no impact on timing of patient discharge. CONCLUSIONS Rapid testing for respiratory viruses has a potentially useful role in antimicrobial stewardship. It is unclear why earlier knowledge of positive viral test didn't lead to less antibiotics in adults. This study showed no impact of rapid testing on time to patient discharge.
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Fowlkes AL, Steffens A, Reed C, Temte JL, Campbell AP. Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016. Open Forum Infect Dis 2019; 6:ofz192. [PMID: 31205973 DOI: 10.1093/ofid/ofz192] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/17/2019] [Indexed: 11/14/2022] Open
Abstract
Background Early influenza antiviral treatment within 2 days of illness onset can reduce illness severity and duration. Reliance on low sensitivity rapid influenza diagnostic tests (RIDTs) to guide antiviral prescribing has been reported. We describe antiviral prescribing practices among primary care providers from a large surveillance network in the United States. Methods From 2009-2016, a network of 36 to 68 outpatient clinics per year collected respiratory specimens and clinical data for patients with influenza-like illness (ILI). Specimens were tested for influenza using polymerase chain reaction (PCR). We used multivariable logistic regression to assess factors influencing antiviral prescribing. Results Among 13 540 patients with ILI, 2766 (20%) were prescribed antivirals. In age groups recommended to receive empiric antiviral treatment for suspected influenza, 11% of children <2 years and 23% of adults ≥65 years received a prescription. Among 3681 patients with a positive PCR test for influenza, 40% tested negative by RIDT. In multivariable analysis, prescription receipt was strongly associated with a positive RIDT (adjusted odds ratio [aOR] 12, 95% CI 11-14) and symptom onset ≤2 days before visit (aOR 4.3, 95% CI 3.8-4.9). Antiviral prescribing was also more frequent among pediatric and private family practice clinics compared with community health centers (aOR 1.9, 95% CI 1.6-2.2, and 1.3, 95% CI 1.1-1.5, respectively). Conclusion Primary care providers were more likely to prescribe antivirals to patients with a positive RIDT, but antivirals were prescribed infrequently even to patients in high-risk age groups. Understanding patient and provider characteristics associated with antiviral prescribing is important for communicating treatment recommendations.
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Affiliation(s)
- Ashley L Fowlkes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Steffens
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan L Temte
- University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin
| | - Angela P Campbell
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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