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Point-of-Care Testing With BioFire Respiratory Panel Helps Optimize Treatments in UK Trial

NEW YORK (GenomeWeb) – Patients who underwent point-of-care diagnostic testing received the right treatment for their respiratory illness faster than those who received the standard of care, according to a new study.

In the ResPOC trial, a team of UK researchers used BioFire Diagnostics' FilmArray Respiratory Panel assay to test half the 720 patients who presented with an acute respiratory illness at University Hospital Southampton. The other half received standard care, which could include a laboratory diagnostic test. The patients had illnesses ranging from influenza and pneumonia to asthma and chronic obstructive pulmonary disease. As they reported in Lancet Respiratory Medicine, patients tested with the POC multiplex PCR assay received the proper treatment more quickly.

This, the researchers said, could help to quickly isolate infectious patients as well as combat antibiotic resistance by avoiding the use of ineffective therapies.

"My vision is that anyone who comes into [the] hospital with an acute respiratory condition will receive this point-of-care test as soon as they come through the hospital door," senior author Tristan Clark, an infectious disease specialist at UHS, said in a statement. "It tells us immediately what virus the person has so, for example, if they have flu they can be isolated in a side room and given antiviral drugs without delay."

Over the course of two winters, he and his colleagues randomly assigned patients presenting to the emergency or acute care departments at Southampton to undergo either POC testing or receive the standard of care. POC testing was performed on nose and throat swabs using the FilmArray Respiratory Panel, a US Food and Drug Administration-cleared and CE-marked multiplex PCR assay from BioMérieux subsidiary BioFire that can detect numerous respiratory viruses, including influenza A or B, rhinovirus, and adenovirus, among half a dozen others. The testing units were located in the emergency department and the acute medical unit.

All patients in the POC testing group underwent molecular respiratory virus testing, while just under half in the control group did, as it was up to their care team whether or not to seek standard laboratory PCR testing. Mean turnaround time for POC testing was 2.3 hours, while it was 37.1 hours for the control group.

About the same portion of people in each group received antibiotic treatment, the researchers reported. They attributed this finding to many patients receiving antibiotics early in their care, before they could be randomly assigned to either testing group or receive testing results.

Currently, patients who have lung infections, which may be bacterial or viral in origin, are often given antibiotics "just in case," Clark added.

Still, he and his colleagues noted that patients in the POC testing group were more likely to have shorter antibiotic courses than the control group. Further, in a subgroup of patients who did not receive antibiotics prior to randomization and testing, the researchers found that 51 percent of people in the testing group received antibiotics as compared to 64 percent in the control group.

Clark and his colleagues also found that there was no difference between the groups in terms of the number of patients treated for influenza with a neuraminidase inhibitor. However, more patients in the POC group had confirmed flu virus infections than in the control group, and those in the POC group who were started empirically on neuraminidase — but who then tested negative for the flu — received a shorter course of treatment. This suggested to the researchers that POC testing could increase the portion of patients receiving the correct treatment.

"Tests like this, which enable tailored and personalized medicine, have a major role to play in the fight against antibiotic resistance," he said.