A quick test for viral infections can reduce unnecessary antibiotic use and hospital admissions, according to research presented at the European Respiratory Society International Congress.
“Respiratory viruses are often underestimated by doctors and patients but can in fact be the cause of most attendances to [the emergency department] for patients with symptoms of respiratory infection,” Kay Roy, MB ChB, MRCP (UK), MRCP (Resp), PhD, consultant physician in respiratory and general internal medicine at West Hertfordshire Hospitals NHS Trust, Watford, England, told Infectious Disease News.
“The automatic reaction is to give antibiotics to all patients without testing to see if the infection is viral or bacterial in origin,” Roy said. “Overprescribing of antibiotics is a global health issue ... due to problems of resistance. We demonstrate an aim to move to targeted and personalized treatment where the prescription is based on the test result to avoid unnecessary antibiotics that can cause side effects and morbidity.”
To review whether the rapid diagnosis of respiratory viruses can optimize antibiotic prescribing and preventing admission in patients presenting acutely with infective respiratory symptoms, Roy and colleagues launched the first service-orientated point-of-care respiratory viral test (POCT) service at Watford General Hospital in the United Kingdom. The test provides results from nasopharyngeal swabs within 45 minutes in the emergency department.
“This is a rapid, yet simple, respiratory viral testing method using a machine the size of an espresso machine,” Roy said. “It takes less than 5 minutes to take the swab from the nose and start the test. Although the same machine and testing is available in the microbiology lab, which is a conventional method across Europe, it can take up to 2 days as opposed to 45 minutes to get a result printout. This leads to huge delays in implementing patient care.”
During the launch, a 2-week trial period beginning Jan. 15, 2018, 130 patients who presented acutely with infective respiratory symptoms were tested. According to researchers, 84 patients tested positive for viruses, including influenza, rhinovirus and coronavirus among others. Forty-seven patients who tested positive were identified as having no clinical indication for antibiotics, although 22 were inappropriately prescribed antibiotics. Roy and colleagues said the remaining 25 were discharged without readmission.
“This respiratory service focused on delivering patient-focused care as early as possible in the patient’s journey with management that is personalized to their POCT result has had a positive impact in our hospital and we hope it will pave the way forward for similar care models in Europe,” Kay said. – by Caitlyn Stulpin
Roy K, et al. Abstract PA2032. Presented at: European Respiratory Society International Congress; September 15-19, 2018; Paris.
Disclosure: The authors report no relevant financial disclosures.