Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences.
NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
Fam Pract. 2021 Sep 25;38(5):598-605. doi: 10.1093/fampra/cmab002.
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).
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.
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.
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.
在英国初级保健中，尚未对快速多病毒呼吸道微生物即时检验（POCT）进行评估。本研究旨在评估多病毒微生物 POCT 在疑似呼吸道感染（RTI）中的应用。
在这项观察性、混合方法可行性研究中，为任何年龄≥3 个月的疑似 RTI 患者提供 POCT 机器。双份咽喉/鼻腔拭子检测 17 种呼吸道病毒和三种非典型细菌，每个样本耗时 65 分钟。
20 名临床医生招募了 93 名患者（估计所有 RTI 病例的 1:3）。患者的中位年龄为 29 岁，57%为女性，44%有合并症。就诊前诊断：上呼吸道感染（48%）；下呼吸道感染（30%）；病毒/流感样疾病（18%）；其他（4%）。中位设置时间为 2.72 分钟，72%的拭子在 4 小时内处理，90%在 24 小时内处理。检测到≥1 种病毒的占 58%，无病原体的占 37%，非典型细菌的占 2%（3%结果不确定）。在未检测到病原体和检测到病毒的患者中，分别有 35%和 25%的患者在就诊前开具了抗生素。20%的患者在就诊后改变了诊断，且诊断确定性增加（P=0.02），阳性结果比阴性结果更明显（P<0.001）。临床医生预测就诊后抗生素获益减少（P=0.02）。访谈显示，POCT 具有明显的潜力，易于使用且深受欢迎，但受到结果报告时间和缺乏对典型呼吸道细菌检测的限制。
这种 POCT 是可以接受的，似乎影响了临床决策。临床医生希望更快的结果报告时间和更多关于细菌的信息。需要进行随机试验来了解这些 POCT 的安全性、有效性和患者认知。
