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

Andrews, Denise; Chetty, Yumela; Cooper, Ben S.; Virk, Manjinder; Glass, Stephen K; Letters, Andrew; Kelly, Philip A.; Sudhanva, Malur; Jeyaratnam, Dakshika

Respiratory tract infections (RTI) place a significant burden on health systems globally, particularly during the annual respiratory season epidemics [1] . Diagnostic tests for respiratory pathogens (RP) are usually laboratorybased with an inherent delay in time to result relating to specimen in transit to the laboratory and laboratory testing schedules, for example once a day, and/or not performed on weekends and holidays. For this reason or due to the nature of the test (culture, serology or batch molecular testing) results are rarely available to the clinician when the patient is first assessed. Consequently, though respiratory viruses are frequently isolated in community acquired pneumonia (CAP) [2] and are reported to be responsible for 12.8% of CAP cases admitted to UK hospitals [3] , the decision to manage as a viral RTI or treat for bacterial infection including Mycoplasma pneumoniae or Chlamydia pneumoniae ('atypical bacteria') is based upon the clinical scenario and severity criteria such as the CURB-65 score. Thus a proportion of infections will be inappropriately managed with antibiotics or the result may arrive too late for influenza treatment to be effective [4] . The World Health Organization (WHO) states that antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections [5] . The Centre for Evidence Based Medicine highlights the considerable number of new diagnostic technologies in development to underpin the rational prescribing of antibiotics [6] , which extends to antivirals.