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Rapid Multiplex Testing for Upper Respiratory Pathogens in the Emergency Department: A Randomized Controlled Trial
Larissa May1, Grant Tatro1, Eduard Poltavskiy2
1Department of Emergency Medicine, University of California Davis, Sacramento, California, USA.
Open Forum Infectious Diseases
|March 5, 2020
Summary
Rapid respiratory panel (RP) testing showed a trend toward reduced antibiotic prescriptions in emergency departments. This suggests faster viral diagnostics may help curb unnecessary antibiotic use for respiratory infections.
Area of Science:
- Infectious Diseases
- Clinical Diagnostics
- Antimicrobial Stewardship
Background:
- Acute upper respiratory tract infections frequently lead to emergency department visits.
- Unnecessary antibiotic prescriptions are common for these infections, contributing to antimicrobial resistance.
Purpose of the Study:
- To evaluate the impact of a rapid, multipathogen respiratory panel (RP) test on antibiotic prescribing in emergency departments.
- To compare RP testing against usual care for patients with upper respiratory or influenza-like illnesses.
Main Methods:
- A randomized clinical trial involving 191 patients aged ≥12 months presenting with respiratory symptoms.
- Primary outcome: antibiotic prescription rate. Secondary outcomes: antiviral prescription, disposition, and length of stay.
- Patients received either rapid RP testing or usual care.
Main Results:
- A virus was detected in 57% of RP patients vs. 7% of usual care patients (P = .0001).
- Antibiotic prescriptions decreased by 12% in the RP group (22%) compared to usual care (34%) (P = .06/.08).
- Greater antibiotic reduction was observed in children (-19%) than adults (-9%).
Conclusions:
- Rapid respiratory panel testing demonstrated a trend towards decreased antibiotic use in the emergency department.
- Faster viral diagnostics show potential for improving antimicrobial stewardship.
- Further research is needed to optimize testing strategies and evaluate cost-effectiveness.
