Current Evidence and Gaps for Outpatient Respiratory Tract Infection Diagnostics: A Call to Action

Area of Science:

• Clinical Microbiology
• Infectious Diseases
• Public Health

Background:

• Antimicrobial stewardship programs (ASPs) are crucial for combating antibiotic resistance but are underrepresented in outpatient settings.
• Upper respiratory tract infections (URIs) account for a significant portion (30%) of outpatient antibiotic prescriptions, indicating a need for improved stewardship.
• Overprescribing of antibiotics in outpatient settings contributes to antimicrobial resistance.

Purpose of the Study:

• To review the role and implementation of rapid diagnostic testing (RDT) in outpatient management of URIs.
• To highlight the potential of RDT, particularly point-of-care testing (POCT), in optimizing antibiotic prescribing practices.
• To identify barriers to RDT implementation and explore strategies for enhanced antimicrobial stewardship in outpatient settings.

Main Methods:

• Review of current literature on outpatient RDT initiatives for URIs.
• Analysis of the impact of RDT on diagnostic accuracy and prescribing behavior.
• Discussion of implementation challenges, including workflow, resources, and ASP integration.

Main Results:

• RDT can facilitate accurate diagnoses for URIs like pharyngitis, leading to optimized prescribing.
• Successful implementation of RDT can significantly reduce unnecessary antimicrobial use.
• Barriers such as lack of streamlined workflows and inadequate ASP support hinder optimal RDT utilization.

Conclusions:

• Enhanced ASP efforts are vital in outpatient settings, with RDT playing a key role in managing URIs.
• Overcoming implementation barriers is essential for maximizing the benefits of RDT in reducing unnecessary antibiotic prescriptions.
• Further research is needed to demonstrate the impact of RDT on clinical outcomes and prescribing patterns in outpatient URIs.