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.
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.
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DOI：
10.1186/s12879-017-2784-z
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发表时间：
2017-10-10
影响因子：
3.7
通讯作者：
Jeyaratnam D
中科院分区：
文献类型：
--
作者：
Andrews D;Chetty Y;Cooper BS;Virk M;Glass SK;Letters A;Kelly PA;Sudhanva M;Jeyaratnam D
基于实验室的呼吸道病原体（RP）结果往往由于标本运输和检测时间表的时间延迟而无法影响诸如住院或抗生素治疗等临床决策。基于病房即护理点（POC）的检测提供快速结果可能改变临床管理途径。FilmArray®RP聚合酶链反应（PCR）系统被放置在三个住院和门诊医疗领域。在2015年1月至7月期间招募出现流感样疾病/上呼吸道感染+/−下呼吸道感染的患者。FilmArray®POC检测在每月的偶数天进行（干预），或在奇数天进行常规的实验室RP - PCR检测+/−非典型血清学检测（对照组）。主要观察指标为住院时间。次要结局是对抗菌素使用、再入院、全因死亡率、住院时间和周转时间（TAT）的影响。在606例符合条件的患者中，纳入545例（89.9%）；211在控制臂，334在干预臂。20%的对照组患者和24%的干预组患者检测到RP。POC检测与主要结局指标（住院时间）无关，但将TAT从39.5 h减少到19.0 h, p < 0.001。只有不同研究组的处方决定不同，p < 0.001。当给予抗病毒药物时，干预与中位时间减少到第一次剂量36小时相关，并允许支原体感染的适当治疗。我们发现呼吸PCR POC检测与住院时间或除抗菌药物处方决定外的大多数次要结局没有关联。这可能是由于启动FilmArray®测试的延迟。尽管如此，与常规的实验室检测相比，POC检测可以显著更快地提供时间紧迫的抗病毒药物、适当的支原体治疗和更快地获得结果。所有年级的病房工作人员都进行了POC测试，没有困难，这表明在许多不同的医疗保健环境中可能使用。需要进一步研究评估快速呼吸PCR POC检测的实施以及对住院时间和抗菌药物使用的影响。ISRCTN10470967，追溯注册，2015年6月30日。
Laboratory-based respiratory pathogen (RP) results are often available too late to influence clinical decisions such as hospitalisation or antibiotic treatment due to time delay in transport of specimens and testing schedules. Ward-based i.e. point of care (POC) testing providing rapid results may alter the clinical management pathway. FilmArray® RP polymerase chain reaction (PCR) systems were placed in three in-patient and out-patient medical areas. Patients presenting with influenza-like illness /upper respiratory tract infection +/− lower RTI were recruited between January–July 2015. FilmArray® POC testing occurred on even days of the month (intervention) or routine, laboratory-based RP PCR testing +/− atypical serology on odd days (control). The primary outcome was length of hospital stay. The secondary outcomes were impact on the use of antimicrobials, readmissions, all-cause mortality, length of ward stay and turn-around time (TAT) (time to result from admission). Of 606 eligible patients, 545 (89.9%) were included; 211 in the control arm and 334 in the intervention arm. 20% of control arm patients and 24% of intervention arm patients had an RP detected. POC testing was not associated with the primary outcome measure, length of stay, but reduced the TAT from 39.5 h to 19.0 h, p < 0.001. Only the prescribing decision differed between study arms, p < 0.001. When antivirals were given, the intervention was associated with a reduction in the median time to the first dose of 36 h and allowed appropriate treatment of mycoplasma infection. We found no association between respiratory PCR POC testing and length of stay or most of the secondary outcomes except the antimicrobial prescribing decision. This was probably due to a delay in initiating FilmArray® testing. Despite this, POC testing allowed time-critical antivirals to be given significantly faster, appropriate mycoplasma treatment and results were available considerably faster than routine, laboratory-based testing. Ward-staff of all grades performed POC testing without difficulty suggesting potential use across many divergent healthcare settings. Further studies evaluating the implementation of rapid respiratory PCR POC testing and the effect on length of stay and antimicrobial use are required. ISRCTN10470967, Retrospectively Registered, 30/6/2015.
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DOI：
10.1016/j.diagmicrobio.2015.08.001
发表时间：
2015-12
影响因子：
2.9
作者：
Gelfer G;Leggett J;Myers J;Wang L;Gilbert DN
通讯作者：
Gilbert DN
DOI：
10.1016/j.diagmicrobio.2016.06.008
发表时间：
2016-09
影响因子：
2.9
作者：
Gilbert D;Gelfer G;Wang L;Myers J;Bajema K;Johnston M;Leggett J
通讯作者：
Leggett J
影响因子：
4.6
作者：
Rogers, Beverly B.;Shankar, Prabhu;Bost, James E.
通讯作者：
Bost, James E.
影响因子：
6.9
作者：
Wu, P. J.;Jeyaratnam, D.;French, G. L.
通讯作者：
French, G. L.
DOI：
10.1016/s2213-2600(17)30120-0
发表时间：
2017-05
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Brendish NJ;Malachira AK;Armstrong L;Houghton R;Aitken S;Nyimbili E;Ewings S;Lillie PJ;Clark TW
通讯作者：
Clark TW