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2796. The Impact of Syndromic Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use in Adults Presenting to Hospital with Exacerbation of Airways Disease: Further Analysis From a Randomized Controlled Trial

BACKGROUND: The ResPOC study demonstrated that syndromic molecular point-of-care testing (POCT) for respiratory viruses was associated with earlier discontinuation of unnecessary antibiotics. Subgroup analysis suggests this occurs predominantly in patients with exacerbation of airways disease. Molec...

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Autores principales: Clark, Tristan William, Mills, Samuel, Brendish, Nathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809665/
http://dx.doi.org/10.1093/ofid/ofz360.2473
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author Clark, Tristan William
Mills, Samuel
Brendish, Nathan
author_facet Clark, Tristan William
Mills, Samuel
Brendish, Nathan
author_sort Clark, Tristan William
collection PubMed
description BACKGROUND: The ResPOC study demonstrated that syndromic molecular point-of-care testing (POCT) for respiratory viruses was associated with earlier discontinuation of unnecessary antibiotics. Subgroup analysis suggests this occurs predominantly in patients with exacerbation of airways disease. Molecular POCT use is becoming widespread but there is a lack of evidence to inform the choice between multiplex syndromic panels vs. uniplex tests for influenza. METHODS: We evaluated patients with exacerbation of asthma or COPD who were treated with antibiotics. The duration of antibiotics and proportion with early discontinuation were compared between patients testing positive for viruses by POCT (FilmArray Respiratory Panel) those testing negative by POCT and controls. Patients testing positive for viruses by POCT were compared according to virus types detected. Survival curves were generated for duration of antibiotics and compared using the log-rank test. RESULTS: There were 118 patient with exacerbation of airways disease in the POCT group who received antibiotics and 111 in the controls. In the POCT group 49/118 (42%) patients tested positive for viruses. Of those testing positive for viruses by POCT 17/49 (35%) had early discontinuation of antibiotics vs. 9/81 (13%) in those testing negative and 7/111 (6%) in controls, P < 0.0001. Survival curve analysis showed a reduced time to antibiotic discontinuation in those testing positive for viruses, P = 0.034. Of those positive for viruses by POCT 20% were positive for influenza, 43% for rhinovirus and 37% for other viruses combined. The proportion with early discontinuation of antibiotics was not different between the virus types, P = 0.53. CONCLUSION: Syndromic molecular POCT for viruses in adults with exacerbation of airways disease leads to early discontinuation in those positive for viruses. As most viruses detected were non-influenza viruses and there was no difference in antibiotic use between virus types, syndromic molecular POCT for respiratory viruses should be favored over uniplex POCT for influenza. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68096652019-10-28 2796. The Impact of Syndromic Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use in Adults Presenting to Hospital with Exacerbation of Airways Disease: Further Analysis From a Randomized Controlled Trial Clark, Tristan William Mills, Samuel Brendish, Nathan Open Forum Infect Dis Abstracts BACKGROUND: The ResPOC study demonstrated that syndromic molecular point-of-care testing (POCT) for respiratory viruses was associated with earlier discontinuation of unnecessary antibiotics. Subgroup analysis suggests this occurs predominantly in patients with exacerbation of airways disease. Molecular POCT use is becoming widespread but there is a lack of evidence to inform the choice between multiplex syndromic panels vs. uniplex tests for influenza. METHODS: We evaluated patients with exacerbation of asthma or COPD who were treated with antibiotics. The duration of antibiotics and proportion with early discontinuation were compared between patients testing positive for viruses by POCT (FilmArray Respiratory Panel) those testing negative by POCT and controls. Patients testing positive for viruses by POCT were compared according to virus types detected. Survival curves were generated for duration of antibiotics and compared using the log-rank test. RESULTS: There were 118 patient with exacerbation of airways disease in the POCT group who received antibiotics and 111 in the controls. In the POCT group 49/118 (42%) patients tested positive for viruses. Of those testing positive for viruses by POCT 17/49 (35%) had early discontinuation of antibiotics vs. 9/81 (13%) in those testing negative and 7/111 (6%) in controls, P < 0.0001. Survival curve analysis showed a reduced time to antibiotic discontinuation in those testing positive for viruses, P = 0.034. Of those positive for viruses by POCT 20% were positive for influenza, 43% for rhinovirus and 37% for other viruses combined. The proportion with early discontinuation of antibiotics was not different between the virus types, P = 0.53. CONCLUSION: Syndromic molecular POCT for viruses in adults with exacerbation of airways disease leads to early discontinuation in those positive for viruses. As most viruses detected were non-influenza viruses and there was no difference in antibiotic use between virus types, syndromic molecular POCT for respiratory viruses should be favored over uniplex POCT for influenza. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809665/ http://dx.doi.org/10.1093/ofid/ofz360.2473 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Clark, Tristan William
Mills, Samuel
Brendish, Nathan
2796. The Impact of Syndromic Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use in Adults Presenting to Hospital with Exacerbation of Airways Disease: Further Analysis From a Randomized Controlled Trial
title 2796. The Impact of Syndromic Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use in Adults Presenting to Hospital with Exacerbation of Airways Disease: Further Analysis From a Randomized Controlled Trial
title_full 2796. The Impact of Syndromic Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use in Adults Presenting to Hospital with Exacerbation of Airways Disease: Further Analysis From a Randomized Controlled Trial
title_fullStr 2796. The Impact of Syndromic Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use in Adults Presenting to Hospital with Exacerbation of Airways Disease: Further Analysis From a Randomized Controlled Trial
title_full_unstemmed 2796. The Impact of Syndromic Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use in Adults Presenting to Hospital with Exacerbation of Airways Disease: Further Analysis From a Randomized Controlled Trial
title_short 2796. The Impact of Syndromic Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use in Adults Presenting to Hospital with Exacerbation of Airways Disease: Further Analysis From a Randomized Controlled Trial
title_sort 2796. the impact of syndromic molecular point-of-care testing for respiratory viruses on antibiotic use in adults presenting to hospital with exacerbation of airways disease: further analysis from a randomized controlled trial
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809665/
http://dx.doi.org/10.1093/ofid/ofz360.2473
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