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

We have selected for patients who required admission and possibly antibiotics by placing the FilmArray® systems on hospital wards. A panel which includes common bacterial causes of lower RTI would probably have identified more pathogens in this setting. A recent study in the UK identified bacteria in lower respiratory tract specimens from 81% of patients with pneumonia [27] . Though we did not record the type of RTI in this study, as in-patients, most patients probably had a lower RTI. A study in the ED might have tested a greater number of patients with a viral illness. There, POC results could provide reassurance that discharge is reasonable. With a rapid result and the broader RP panel afforded by Fil-mArray®, it is plausible that safety-netting antibiotic prescriptions would have reduced. Due to the mandated maximum 4-h wait for patients in English EDs [30] and a perceived lack of understanding of these results vocalised by our ED staff (because with laboratory-based testing the patient has left ED when results are available), we moved the study one step in to the hospital. This highlights an important knowledge gap. An ED-based study of POC testing incorporating decision making support is therefore advisable.