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J Clin Microbiol. 2019 Jan 2. pii: JCM.01281-18. doi: 10.1128/JCM.01281-18. [Epub ahead of print]
Clinical Impact of Rapid Point-of-Care Polymerase Chain Reaction Influenza Testing In An Urgent Care Setting: A Single Center Study.
Benirschke RC1,2, McElvania E1, Thomson R1,2, Kaul K1,2, Das S3,2.
Author information
Abstract
Seasonal influenza virus causes significant morbidity and mortality each year. Point-of-care (POC) testing using rapid influenza diagnostic tests (RIDTs), immunoassays that detect viral antigens, are often used for diagnosis by physician offices and urgent care centers. These tests are rapid but lack sensitivity, which is estimated to be 50-70%. Testing by polymerase chain reaction (PCR) is highly sensitive and specific, but historically these assays have been performed in centralized clinical laboratories necessitating specimen transport and increasing the time to result. Recently, Clinical Laboratory Improvement Amendments (CLIA)-waived, POC PCR influenza assays have been developed with >95% sensitivity and specificity when compared to centralized PCR assays. To determine the clinical impact of a POC PCR test for influenza, we compared antimicrobial prescribing patterns of one urgent care location using this method to other urgent cares in our health system using traditional RIDT with negative specimens being reflexed to PCR. Antiviral prescribing was lower in patients with a negative LIAT PCR result (2.3%) than with a negative RIDT result (25.3%); p<0.005. Antivirals were prescribed more often in patients that tested positive by LIAT PCR (82.4%) when compared to those positive by either RIDT or reflex PCR (69.9%); p<0.05. Antibacterial prescriptions for patients testing negative by LIAT PCR were higher (44.5%) than those testing negative by RIDT (37.7%), although the difference was not statistically significant. In conclusion, having results from a PCR POC test during the clinic visit improved antiviral prescribing practices when compared to having rapid results from an RIDT.
PMID: 30602445 DOI: 10.1128/JCM.01281-18
Clinical Impact of Rapid Point-of-Care Polymerase Chain Reaction Influenza Testing In An Urgent Care Setting: A Single Center Study.
Benirschke RC1,2, McElvania E1, Thomson R1,2, Kaul K1,2, Das S3,2.
Author information
Abstract
Seasonal influenza virus causes significant morbidity and mortality each year. Point-of-care (POC) testing using rapid influenza diagnostic tests (RIDTs), immunoassays that detect viral antigens, are often used for diagnosis by physician offices and urgent care centers. These tests are rapid but lack sensitivity, which is estimated to be 50-70%. Testing by polymerase chain reaction (PCR) is highly sensitive and specific, but historically these assays have been performed in centralized clinical laboratories necessitating specimen transport and increasing the time to result. Recently, Clinical Laboratory Improvement Amendments (CLIA)-waived, POC PCR influenza assays have been developed with >95% sensitivity and specificity when compared to centralized PCR assays. To determine the clinical impact of a POC PCR test for influenza, we compared antimicrobial prescribing patterns of one urgent care location using this method to other urgent cares in our health system using traditional RIDT with negative specimens being reflexed to PCR. Antiviral prescribing was lower in patients with a negative LIAT PCR result (2.3%) than with a negative RIDT result (25.3%); p<0.005. Antivirals were prescribed more often in patients that tested positive by LIAT PCR (82.4%) when compared to those positive by either RIDT or reflex PCR (69.9%); p<0.05. Antibacterial prescriptions for patients testing negative by LIAT PCR were higher (44.5%) than those testing negative by RIDT (37.7%), although the difference was not statistically significant. In conclusion, having results from a PCR POC test during the clinic visit improved antiviral prescribing practices when compared to having rapid results from an RIDT.
PMID: 30602445 DOI: 10.1128/JCM.01281-18