tetano
Editor, Senior Moderator
Clin Microbiol Infect. 2019 Jun 26. pii: S1198-743X(19)30370-2. doi: 10.1016/j.cmi.2019.06.024. [Epub ahead of print]
[h=1]Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes.[/h] Thornton HV[SUP]1[/SUP], Turner KM[SUP]2[/SUP], Harrison S[SUP]3[/SUP], Hammond A[SUP]1[/SUP], Hawcroft C[SUP]1[/SUP], Hay AD[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Microbial point-of-care testing (POCT) has potential to revolutionise clinical care. Understanding prognostic value of microbes identified from the upper respiratory tract (a convenient sampling site) is a necessary first step to understand potential for upper respiratory tract POCTs in assisting antimicrobial treatment decisions for respiratory infections (RTIs).
[h=4]OBJECTIVES:[/h] To investigate the relationship between upper respiratory tract microbial detection and disease prognosis, including effects of antimicrobial use.
[h=4]DATA SOURCES:[/h] MEDLINE and Embase databases.
[h=4]STUDY ELIGIBILITY CRITERIA:[/h] Quantitative studies reporting microbiological and prognostic data from patients of all age groups presenting with RTI.
[h=4]PARTICIPANTS:[/h] Patients presenting to healthcare or research settings with RTI.
[h=4]INTERVENTIONS:[/h] Upper respiratory tract swab.
[h=4]METHODS:[/h] Systematic review and meta-analysis.
[h=4]RESULTS:[/h] Searches identified 5156 articles, of which 754 were duplicates and 4258 excluded on title or abstract. 144 full texts were screened;21 articles retained. Studies reported data for 15 microbes and 26 prognostic measures (390 potential associations). 107 (27%) associations were investigated statistically, of which 38 (36%) were significant. Most studies reported only prognostic value of test positive results. Meta-analyses suggested hospitalisation duration was longer for patients with respiratory syncytial virus than adenovirus and influenza, but significant heterogeneity was observed between studies.
[h=4]CONCLUSIONS:[/h] A quarter of potential prognostic associations have been investigated. Of these, a third were significant, suggesting considerable potential for POCT. Future research should investigate prognostic value of positive and negative tests, and interactions between test result, use of antimicrobials and microbial resistance.
Copyright ? 2019. Published by Elsevier Ltd.
[h=4]KEYWORDS:[/h] Antibacterial; Antimicrobial stewardship; Diagnosis; Point of care test; Primary care
PMID: 31254715 DOI: 10.1016/j.cmi.2019.06.024
[h=1]Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes.[/h] Thornton HV[SUP]1[/SUP], Turner KM[SUP]2[/SUP], Harrison S[SUP]3[/SUP], Hammond A[SUP]1[/SUP], Hawcroft C[SUP]1[/SUP], Hay AD[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Microbial point-of-care testing (POCT) has potential to revolutionise clinical care. Understanding prognostic value of microbes identified from the upper respiratory tract (a convenient sampling site) is a necessary first step to understand potential for upper respiratory tract POCTs in assisting antimicrobial treatment decisions for respiratory infections (RTIs).
[h=4]OBJECTIVES:[/h] To investigate the relationship between upper respiratory tract microbial detection and disease prognosis, including effects of antimicrobial use.
[h=4]DATA SOURCES:[/h] MEDLINE and Embase databases.
[h=4]STUDY ELIGIBILITY CRITERIA:[/h] Quantitative studies reporting microbiological and prognostic data from patients of all age groups presenting with RTI.
[h=4]PARTICIPANTS:[/h] Patients presenting to healthcare or research settings with RTI.
[h=4]INTERVENTIONS:[/h] Upper respiratory tract swab.
[h=4]METHODS:[/h] Systematic review and meta-analysis.
[h=4]RESULTS:[/h] Searches identified 5156 articles, of which 754 were duplicates and 4258 excluded on title or abstract. 144 full texts were screened;21 articles retained. Studies reported data for 15 microbes and 26 prognostic measures (390 potential associations). 107 (27%) associations were investigated statistically, of which 38 (36%) were significant. Most studies reported only prognostic value of test positive results. Meta-analyses suggested hospitalisation duration was longer for patients with respiratory syncytial virus than adenovirus and influenza, but significant heterogeneity was observed between studies.
[h=4]CONCLUSIONS:[/h] A quarter of potential prognostic associations have been investigated. Of these, a third were significant, suggesting considerable potential for POCT. Future research should investigate prognostic value of positive and negative tests, and interactions between test result, use of antimicrobials and microbial resistance.
Copyright ? 2019. Published by Elsevier Ltd.
[h=4]KEYWORDS:[/h] Antibacterial; Antimicrobial stewardship; Diagnosis; Point of care test; Primary care
PMID: 31254715 DOI: 10.1016/j.cmi.2019.06.024