Evaluation of a molecular point-of-care testing for viral and atypical pathogens on intravenous antibiotic duration in hospitalized adults with lower respiratory tract infection: a randomized clinical trial

D Shengchen, X Gu, G Fan, R Sun, Y Wang, D Yu, H Li, F Zhou, Z Xiong, B Lu, G Zhu, B Cao, D Shengchen, X Gu, G Fan, R Sun, Y Wang, D Yu, H Li, F Zhou, Z Xiong, B Lu, G Zhu, B Cao

Abstract

Objectives: The primary objective was to evaluate whether a molecular point-of-care test (POCT) for viral and atypical pathogens added to routine real-time PCR could reduce duration of intravenous antibiotics in hospitalized patients with lower respiratory tract infection (LRTI) compared with routine real-time PCR.

Methods: In this single-centre, open-label, randomized controlled study, we enrolled hospitalized adults diagnosed with LRTI. Patients were randomized to an intervention group (POCT FilmArray Panel for 20 viruses, atypical pathogens and bacteria plus routine real-time PCR) or a control group (routine real-time PCR for ten pathogens). The primary outcome was duration of intravenous antibiotics during hospitalization. The secondary outcomes included length of stay, cost of hospitalization and de-escalation within 72 hours and between 72 hours and 7 days. Intention-to-treat analysis was used.

Results: Between October 2017 and July 2018, we enrolled 800 eligible patients (398 in the intervention group and 402 in the control group). Duration of intravenous antibiotics in the intervention group was shorter than in the control (7.0 days (interquartile range (IQR) 5.0-9.0) versus 8.0 days (IQR 6.0-11.0); p <0.001). Length of hospital stay in the intervention group was significantly shorter (8.0 days (IQR 7.0-11.0) versus 9.0 days (IQR 7.0-12.0; p <0.001) and the cost of hospitalization in the intervention group was significantly lower ($1804.7 (IQR 1298.4-2633.8) versus $2042.5 (IQR 1427.4-2926.2); p 0.002) than control group. More patients in the intervention group achieved de-escalation within 72 hours (7.9%, 29/367 versus 3.2%, 12/377; p 0.005) and between 72 hours and 7 days (29.7%, 109/367 versus 22.0%, 83/377; p 0.024).

Conclusions: Use of molecular POCT testing for respiratory viruses and atypical pathogens might help to reduce intravenous antibiotic use in hospitalized LRTI patients.

Clinical trial registration: clinicaltrials.gov Identifier: NCT03391076.

Keywords: Acute exacerbation of bronchiectasis; Acute exacerbation of chronic obstructive pulmonary disease; Community-acquired pneumonia; FilmArray Respiratory Panel; Lower respiratory tract infection; Molecular point-of-care testing.

Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Trial profile. Abbreviations: ANCA, anti-neutrophil cytoplasmic antibody; COPD, chronic obstructive pulmonary disease; CTD-ILD, connective tissue diseases–interstitial lung disease; HIV, human immunodeficiency virus; POCT, point-of-care testing.
Fig. 2
Fig. 2
Time to withdrawal of intravenous antibiotics (intention-to-treat analysis).

References

    1. World Health Organization. World health report: the ten most common infections. Available at: , accessed 11 September 2017.
    1. World Health Organization. Fact sheet 310: the top 10 causes of death. Available at: , accessed 11 September 2017.
    1. World Health Organization. Battle against respiratory viruses initiative. Available at: , accessed 11 September 2017.
    1. Crotty M.P., Meyers S., Hampton N., Bledsoe S., Ritchie D.J., Buller R.S. Impact of antibacterials on subsequent resistance and clinical outcomes in adult patients with viral pneumonia: an opportunity for stewardship. Crit Care. 2015;19:404.
    1. Xiao Y.H. Bacterial resistance: challenge and strategies. China Lic Pharm. 2011;8:3–8.
    1. Wang Z., Zhang H., Han J., Xing H., Wu M.C., Yang T. Deadly sins of antibiotic abuse in China. Infect Contr Hosp Epidemiol. 2017;38:758–759.
    1. Zhang Q.Q., Ying G.G., Pan C.G., Liu Y.S., Zhao J.L. Comprehensive evaluation of antibiotics emission and fate in the river basins of China: source analysis, multimedia modeling, and linkage to bacterial resistance. Environ Sci Technol. 2015;49:6772–6782.
    1. Zhou Q., He B., Zhu H. Potential for cost-savings in the care of hospitalized low-risk community-acquired pneumonia patients in China. Value in Health. 2009;12:40–46.
    1. Brendish N.J., Malachira A.K., Armstrong L., Houghton R., Aitken S., Nyimbili E. Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial. Lancet Respir Med. 2017;5:401–411.
    1. Gelfer G., Leggett J., Myers J., Wang L., Gilbert D.N. The clinical impact of the detection of potential etiologic pathogens of community-acquired pneumonia. Diagn Microbiol Infect Dis. 2015;83:400–406.
    1. Andrews D., Chetty Y., Cooper B.S., Virk M., Glass S.K., Letters A. Multiplex PCR point of care testing versus routine, laboratory-based testing in the treatment of adults with respiratory tract infections: a quasi-randomised study assessing impact on length of stay and antimicrobial use. BMC Infect Dis. 2017;17:671.
    1. Poritz M.A., Blaschke A.J., Byington C.L., Meyers L., Nilsson K., Jones D.E. FilmArray, an automated nested multiplex PCR system for multi-pathogen detection: development and application to respiratory tract infection. PLoS One. 2011;6
    1. Chan M., Koo S.H., Jiang B., Lim P.Q., Tan T.Y. Comparison of the biofire FilmArray respiratory panel, Seegene AnyplexII RV16, and Argene for the detection of respiratory viruses. J Clin Virol. 2018;106:13–17.
    1. Branche A.R., Walsh E.E., Vargas R., Hulbert B., Formica M.A., Baran A. Serum procalcitonin measurement and viral testing to guide antibiotic use for respiratory infections in hospitalized adults: a randomized controlled trial. J Infect Dis. 2015;212:1692–1700.
    1. Rappo U., Schuetz A.N., Jenkins S.G., Calfee D.P., Walsh T.J., Wells M.T. Impact of early detection of respiratory viruses by multiplex PCR assay on clinical outcomes in adult patients. J Clin Microbiol. 2016;54:2096–2103.
    1. Cao B., Huang Y., She D.Y., Cheng Q.J., Fan H., Tian X.L. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. Clin Respir J. 2018;12:1320–1360.
    1. Cai B.Q., Cai S.X., Chen R.C., Cui L.Y., Feng Y.L., Gu Y.T. Expert consensus on acute exacerbation of chronic obstructive pulmonary disease in the People's Republic of China. Int J Chron Obstruct Pulmon Dis. 2014;9:381–395.
    1. Cai B.Q., He Q.Y., Gao Z.C., Cao Z.L., Ma Y.L., Yang R.H. [Expert consensus on bronchiectasis for adults in China] Zhonghua Jie He He Hu Xi Za Zhi. 2012;35:485–492.
    1. Subramony A., Zachariah P., Krones A., Whittier S., Saiman L. Impact of multiplex polymerase chain reaction testing for respiratory pathogens on healthcare resource utilization for pediatric inpatients. J Pediatr. 2016;173:196–201.e2.
    1. Rogers B.B., Shankar P., Jerris R.C., Kotzbauer D., Anderson E.J., Watson J.R. Impact of a rapid respiratory panel test on patient outcomes. Arch Pathol Lab Med. 2015;139:636–641.
    1. Keske S., Ergonul O., Tutucu F., Karaaslan D., Palaoglu E., Can F. The rapid diagnosis of viral respiratory tract infections and its impact on antimicrobial stewardship programs. Eur J Clin Microbiol Infect Dis. 2018;37:779–783.
    1. Gilbert D., Gelfer G., Wang L., Myers J., Bajema K., Johnston M. The potential of molecular diagnostics and serum procalcitonin levels to change the antibiotic management of community-acquired pneumonia. Diagn Microbiol Infect Dis. 2016;86:102–107.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir