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Repeat Molecular Testing for Respiratory Pathogens: Diagnostic Gain or Diminishing Returns?
Abraham J Qavi1, Allison McMullen1, Carey-Ann D Burnham1
1Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO.
The Journal of Applied Laboratory Medicine
|July 17, 2020
Summary
Repeat testing for respiratory pathogens using nucleic acid amplification tests (NAATs) is common. While some repeat tests yield new detections, they often lack clinical actionability, suggesting a need to optimize diagnostic stewardship.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Diagnostic Testing
Background:
- Upper respiratory tract infections (URTIs) are prevalent, necessitating accurate and rapid pathogen identification for effective patient management.
- Nucleic acid amplification tests (NAATs) are crucial for diagnosing respiratory pathogens.
Purpose of the Study:
- To evaluate test-ordering practices for two common NAATs: Xpert Flu Assay and Biofire FilmArray respiratory panel (RP) assay.
- To assess the frequency and clinical utility of repeat respiratory pathogen testing within seven days of an initial test.
Main Methods:
- Retrospective analysis of test-ordering data for Xpert Flu Assay and Biofire FilmArray RP assay.
- Examination of repeat testing instances and the diagnostic yield of these repeat tests.
Main Results:
- Repeat testing occurred in 3.0% of Flu assays and 10.0% of RP assays.
- Repeat testing yielded new pathogen detections in 2.7% of Flu assays and 6.0% of RP assays, but these were not always clinically actionable.
- Discrepancies in influenza results between Flu assay and RP assay were low (1.3%).
Conclusions:
- Opportunities exist to refine ordering practices for respiratory pathogen NAATs to improve clinical yield.
- Limiting repeat testing can enhance diagnostic stewardship and optimize resource utilization.
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