即时检测呼吸道病毒对气道疾病加重的成年患者抗生素使用的影响。

Impact of point-of-care testing for respiratory viruses on antibiotic use in adults with exacerbation of airways disease.

机构信息

Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, LF101, South Academic block, Southampton General Hospital, Southampton SO16 6YD, UK.

Department of Infection, University Hospital Southampton NHS Foundation Trust, LF101, South Academic block, Southampton General Hospital, Southampton SO16 6YD, UK.

出版信息

J Infect. 2019 Oct;79(4):357-362. doi: 10.1016/j.jinf.2019.06.010. Epub 2019 Jun 21.

BACKGROUND

The ResPOC study demonstrated that syndromic molecular point-of-care testing (POCT) for respiratory viruses was associated with early discontinuation of unnecessary antibiotics compared to routine clinical care. Subgroup analysis suggests these changes occur predominantly in patients with exacerbation of airways disease. Use of molecular POCT for respiratory viruses is becoming widespread but there is a lack of evidence to inform the choice between multiplex syndromic panels versus POCT for influenza only.

MATERIALS/METHODS: We evaluated patients from the ResPOC study with exacerbation of asthma or COPD who were treated with antibiotics. The duration of antibiotics and proportion with early discontinuation were compared between patients testing positive and negative for viruses by POCT, and controls. Patients testing positive for viruses by POCT were compared according to virus types.

RESULTS

118 patient with exacerbation of airways disease received antibiotics in the POCT group and 111 in the control group. In the POCT group 49/118 (42%) patients tested positive for viruses. Of those testing positive for viruses 17/49 (35%) had early discontinuation of antibiotics versus 9/69 (13%) testing negative and 7/111 (6%) of controls, p<0.0001. Of those positive for viruses by POCT 10/49 (20%) were positive for influenza, 21/49 (43%) for rhinovirus and 18/49 (37%) for other viruses. The proportion with early discontinuation of antibiotics was not different between the virus types (p = 0.34).

CONCLUSIONS

This data suggests that syndromic molecular POCT for respiratory viruses should be favoured over POCT for influenza alone in adults with exacerbation of airways disease.

背景

ResPOC 研究表明，与常规临床护理相比，针对呼吸道病毒的综合征分子即时检验（POCT）可促使及早停止使用不必要的抗生素。亚组分析表明，这些变化主要发生在气道疾病恶化的患者中。尽管针对呼吸道病毒的分子 POCT 的应用越来越广泛，但缺乏相关证据来指导选择针对呼吸道病毒的多重综合征检测试剂盒与仅针对流感的 POCT 试剂盒。

材料/方法：我们评估了 ResPOC 研究中因哮喘或 COPD 加重而接受抗生素治疗的患者。比较了 POCT 检测病毒阳性和阴性患者以及对照组中抗生素的使用时间和早期停药比例。根据病毒类型比较了 POCT 检测病毒阳性的患者。

结果

POCT 组中 118 例气道疾病恶化患者接受了抗生素治疗，对照组中 111 例。POCT 组中 49/118（42%）例患者病毒检测阳性。在病毒检测阳性的患者中，有 17/49（35%）例患者早期停用了抗生素，而病毒检测阴性的患者有 9/69（13%）例和对照组中有 7/111（6%）例，p<0.0001。在 POCT 检测病毒阳性的患者中，有 10/49（20%）例患者流感病毒阳性，21/49（43%）例患者鼻病毒阳性，18/49（37%）例患者其他病毒阳性。不同病毒类型患者的抗生素早期停药比例无差异（p = 0.34）。