Kuitunen Ilari, Renko Marjo
Department of Pediatrics, University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland.
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
Open Forum Infect Dis. 2023 Aug 18;10(9):ofad443. doi: 10.1093/ofid/ofad443. eCollection 2023 Sep.
Rapid point-of-care testing for respiratory pathogens has gained increasing popularity, but its impact on antibiotic consumption is unclear. Thus, the aim of this systematic review and meta-analysis was to estimate the effect of rapid point-of-care testing on antibiotic prescriptions.
The search for this systematic review with meta-analysis was performed in February 2023. Randomized controlled trials investigating the impact of testing for respiratory pathogens in all-aged patients were included regardless of the comparator. The main outcome was the antibiotic prescription rate. Analyses were stratified by test type, test setting, and patient age. A random-effects Mantel-Haenszel model was used to calculate risk ratios with 95% confidence intervals. Risk of bias was assessed for included studies, and the quality of the evidence was rated according to GRADE.
A total of 754 abstracts were screened, and 10 studies were included in the analysis. Risk of bias was high in 2, low in 4, and had some concerns in 4 studies. Four studies analyzed influenza and respiratory syncytial virus tests, and 6 studies analyzed multiplex (viral and/or bacterial) testing. The prescription rate was 48.2% (496/1029) in the influenza and respiratory syncytial virus test group and 48.7% (540/1109) in the control group (risk ratio [RR], 0.97; 95% CI, 0.92-1.02; moderate-quality evidence). The prescription rate in the multiplex testing group was 54.3% (1554/2859), and it was 57.3% (1336/2326) in the control group (RR, 1.00; 95% CI, 0.96-1.04; moderate-quality evidence). In an age-stratified analysis, the prescription rates showed no evidence of a difference (children: RR, 1.03; 95% CI, 0.81-1.30; adults: RR, 0.98; 95% CI, 0.96-1.01; very low- and moderate-quality evidence).
We found moderate-quality evidence that rapid point-of-care testing for respiratory pathogens does not decrease the antibiotic prescription rate.
呼吸道病原体即时检测日益普及，但其对抗生素使用的影响尚不清楚。因此，本系统评价和荟萃分析的目的是评估即时检测对抗生素处方的影响。
2023年2月进行了本次包含荟萃分析的系统评价检索。纳入了调查所有年龄段患者呼吸道病原体检测影响的随机对照试验，不考虑对照物。主要结局是抗生素处方率。分析按检测类型、检测地点和患者年龄分层。采用随机效应Mantel-Haenszel模型计算风险比及95%置信区间。对纳入研究评估偏倚风险，并根据GRADE对证据质量进行评级。
共筛选754篇摘要，10项研究纳入分析。2项研究偏倚风险高，4项低，4项存在一些担忧。4项研究分析了流感和呼吸道合胞病毒检测，6项研究分析了多重（病毒和/或细菌）检测。流感和呼吸道合胞病毒检测组的处方率为48.2%（496/1029），对照组为48.7%（540/1109）（风险比[RR]，0.97；95%置信区间，0.92-1.02；中等质量证据）。多重检测组的处方率为54.3%（1554/2859），对照组为57.3%（1336/2326）（RR，1.00；95%置信区间，0.96-1.04；中等质量证据）。在年龄分层分析中，处方率无差异证据（儿童：RR，1.03；95%置信区间，0.81-1.30；成人：RR，0.98；95%置信区间，0.96-1.01；极低和中等质量证据）。
我们发现中等质量证据表明，呼吸道病原体即时检测不会降低抗生素处方率。
