Novel multi-virus rapid respiratory microbiological point-of-care testing in primary care: a mixed-methods feasibility evaluation

Tanzeela Y. Khalid, Lorna J. Duncan, Hannah V. Thornton, Gemma Lasseter, Peter Muir, Zara Abigail Toney, Alastair D. Hay

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND AND OBJECTIVES: Rapid multi-viral respiratory microbiological point-of-care tests (POCTs) have not been evaluated in UK primary care. The aim of this study was to evaluate the use of a multi-viral microbiological POCT for suspected respiratory tract infections (RTIs). 

METHODS: In this observational, mixed-methods feasibility study practices were provided with a POCT machine for any patient aged ≥3 months with suspected RTI. Dual throat/nose swabs tested for 17 respiratory viruses and three atypical bacteria, 65 minutes per sample. 

RESULTS: Twenty clinicians recruited 93 patients (estimated 1:3 of all RTI cases). Patient's median age was 29, 57% female, and 44% with co-morbidities. Pre-test diagnoses: upper RTI (48%); lower RTI (30%); viral/influenza-like illness (18%); other (4%). Median set-up time was 2.72 minutes, with 72% swabs processed <4 hours, 90% <24 hours. Tests detected ≥1 virus in 58%, no pathogen 37% and atypical bacteria 2% (3% inconclusive). Antibiotics were prescribed pre-test to 35% of patients with no pathogen detected and 25% with a virus. Post-test diagnoses changed in 20%, and diagnostic certainty increased (P = 0.02), more so when the test was positive rather than negative (P < 0.001). Clinicians predicted decreased antibiotic benefit post-test (P = 0.02). Interviews revealed the POCT has clear potential, was easy to use and well-liked, but limited by time-to-result and the absence of testing for typical respiratory bacteria. 

CONCLUSIONS: This POCT was acceptable and appeared to influence clinical reasoning. Clinicians wanted faster time-to-results and more information about bacteria. Randomized trials are needed to understand the safety, efficacy and patient perceptions of these POCTs.

Original languageEnglish
Pages (from-to)598-605
Number of pages8
JournalFamily Practice
Volume38
Issue number5
Early online date4 Mar 2021
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information: The RAPID-TEST study at the University of Bristol was funded by the National Institute for Health Research (NIHR) School for Primary Care Research (project reference 391). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The authors have no conflicts of interest to declare.

Open Access: Free to read, but no Open Access licence

Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press. All rights reserved.

Citation: Tanzeela Y Khalid, Lorna J Duncan, Hannah V Thornton, Gemma Lasseter, Peter Muir, Zara Abigail Toney, Alastair D Hay, Novel multi-virus rapid respiratory microbiological point-of-care testing in primary care: a mixed-methods feasibility evaluation, Family Practice, Volume 38, Issue 5, October 2021, Pages 598–605,

DOI: https://doi.org/10.1093/fampra/cmab002

Keywords

  • Bacterial
  • diagnosis
  • point-of-care testing
  • primary health care
  • respiratory tract infections
  • viral

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