Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes

H. V. Thornton; K. M.E. Turner; S. Harrison; A. Hammond; C. Hawcroft; A. D. Hay

doi:10.1016/j.cmi.2019.06.024

Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes

H. V. Thornton, K. M.E. Turner, S. Harrison, A. Hammond, C. Hawcroft, A. D. Hay^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

10 Citations (Scopus)

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Abstract

BACKGROUND: Microbial point-of-care testing (POCT) has potential to revolutionise clinical care. Understanding prognostic value of microbes identified from the upper respiratory tract (a convenient sampling site) is a necessary first step to understand potential for upper respiratory tract POCTs in assisting antimicrobial treatment decisions for respiratory infections (RTIs).

OBJECTIVES: To investigate the relationship between upper respiratory tract microbial detection and disease prognosis, including effects of antimicrobial use.

DATA SOURCES: MEDLINE and Embase databases.

STUDY ELIGIBILITY CRITERIA: Quantitative studies reporting microbiological and prognostic data from patients of all age groups presenting with RTI.

PARTICIPANTS: Patients presenting to healthcare or research settings with RTI.

INTERVENTIONS: Upper respiratory tract swab.

METHODS: Systematic review and meta-analysis.

RESULTS: Searches identified 5156 articles, of which 754 were duplicates and 4258 excluded on title or abstract. 144 full texts were screened;21 articles retained. Studies reported data for 15 microbes and 26 prognostic measures (390 potential associations). 107 (27%) associations were investigated statistically, of which 38 (36%) were significant. Most studies reported only prognostic value of test positive results. Meta-analyses suggested hospitalisation duration was longer for patients with respiratory syncytial virus than adenovirus and influenza, but significant heterogeneity was observed between studies.

CONCLUSIONS: A quarter of potential prognostic associations have been investigated. Of these, a third were significant, suggesting considerable potential for POCT. Future research should investigate prognostic value of positive and negative tests, and interactions between test result, use of antimicrobials and microbial resistance.

Original language	English
Pages (from-to)	1339 - 1346
Number of pages	8
Journal	Clinical Microbiology and Infection
Volume	25
Issue number	11
Early online date	26 Jun 2019
DOIs	https://doi.org/10.1016/j.cmi.2019.06.024
Publication status	Published - 1 Nov 2019

Keywords

Antibacterial
Antimicrobial stewardship
Diagnosis
Point-of-care test
Primary care

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10.1016/j.cmi.2019.06.024

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This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://doi.org/10.1016/j.cmi.2019.06.024. Please refer to any applicable terms of use of the publisher.
Accepted author manuscript, 413 KBLicence: CC BY-NC-ND
Full-text PDF (author’s accepted manuscript)
This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://doi.org/10.1016/j.cmi.2019.06.024 . Please refer to any applicable terms of use of the publisher.
Accepted author manuscript, 553 KBLicence: CC BY-NC-ND

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@article{ab598539ed0845639e7ae8f1c0df63f6,

title = "Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes",

abstract = "BACKGROUND: Microbial point-of-care testing (POCT) has potential to revolutionise clinical care. Understanding prognostic value of microbes identified from the upper respiratory tract (a convenient sampling site) is a necessary first step to understand potential for upper respiratory tract POCTs in assisting antimicrobial treatment decisions for respiratory infections (RTIs).OBJECTIVES: To investigate the relationship between upper respiratory tract microbial detection and disease prognosis, including effects of antimicrobial use.DATA SOURCES: MEDLINE and Embase databases.STUDY ELIGIBILITY CRITERIA: Quantitative studies reporting microbiological and prognostic data from patients of all age groups presenting with RTI.PARTICIPANTS: Patients presenting to healthcare or research settings with RTI.INTERVENTIONS: Upper respiratory tract swab.METHODS: Systematic review and meta-analysis.RESULTS: Searches identified 5156 articles, of which 754 were duplicates and 4258 excluded on title or abstract. 144 full texts were screened;21 articles retained. Studies reported data for 15 microbes and 26 prognostic measures (390 potential associations). 107 (27%) associations were investigated statistically, of which 38 (36%) were significant. Most studies reported only prognostic value of test positive results. Meta-analyses suggested hospitalisation duration was longer for patients with respiratory syncytial virus than adenovirus and influenza, but significant heterogeneity was observed between studies.CONCLUSIONS: A quarter of potential prognostic associations have been investigated. Of these, a third were significant, suggesting considerable potential for POCT. Future research should investigate prognostic value of positive and negative tests, and interactions between test result, use of antimicrobials and microbial resistance.",

keywords = "Antibacterial, Antimicrobial stewardship, Diagnosis, Point-of-care test, Primary care",

author = "Thornton, {H. V.} and Turner, {K. M.E.} and S. Harrison and A. Hammond and C. Hawcroft and Hay, {A. D.}",

year = "2019",

month = nov,

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doi = "10.1016/j.cmi.2019.06.024",

language = "English",

volume = "25",

pages = "1339 -- 1346",

journal = "Clinical Microbiology and Infection",

issn = "1198-743X",

publisher = "Elsevier Limited",

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}

Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes. / Thornton, H. V.; Turner, K. M.E.; Harrison, S. et al.
In: Clinical Microbiology and Infection, Vol. 25, No. 11, 01.11.2019, p. 1339 - 1346.

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

TY - JOUR

T1 - Assessing the potential of upper respiratory tract point-of-care testing

T2 - a systematic review of the prognostic significance of upper respiratory tract microbes

AU - Thornton, H. V.

AU - Turner, K. M.E.

AU - Harrison, S.

AU - Hammond, A.

AU - Hawcroft, C.

AU - Hay, A. D.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: Microbial point-of-care testing (POCT) has potential to revolutionise clinical care. Understanding prognostic value of microbes identified from the upper respiratory tract (a convenient sampling site) is a necessary first step to understand potential for upper respiratory tract POCTs in assisting antimicrobial treatment decisions for respiratory infections (RTIs).OBJECTIVES: To investigate the relationship between upper respiratory tract microbial detection and disease prognosis, including effects of antimicrobial use.DATA SOURCES: MEDLINE and Embase databases.STUDY ELIGIBILITY CRITERIA: Quantitative studies reporting microbiological and prognostic data from patients of all age groups presenting with RTI.PARTICIPANTS: Patients presenting to healthcare or research settings with RTI.INTERVENTIONS: Upper respiratory tract swab.METHODS: Systematic review and meta-analysis.RESULTS: Searches identified 5156 articles, of which 754 were duplicates and 4258 excluded on title or abstract. 144 full texts were screened;21 articles retained. Studies reported data for 15 microbes and 26 prognostic measures (390 potential associations). 107 (27%) associations were investigated statistically, of which 38 (36%) were significant. Most studies reported only prognostic value of test positive results. Meta-analyses suggested hospitalisation duration was longer for patients with respiratory syncytial virus than adenovirus and influenza, but significant heterogeneity was observed between studies.CONCLUSIONS: A quarter of potential prognostic associations have been investigated. Of these, a third were significant, suggesting considerable potential for POCT. Future research should investigate prognostic value of positive and negative tests, and interactions between test result, use of antimicrobials and microbial resistance.

AB - BACKGROUND: Microbial point-of-care testing (POCT) has potential to revolutionise clinical care. Understanding prognostic value of microbes identified from the upper respiratory tract (a convenient sampling site) is a necessary first step to understand potential for upper respiratory tract POCTs in assisting antimicrobial treatment decisions for respiratory infections (RTIs).OBJECTIVES: To investigate the relationship between upper respiratory tract microbial detection and disease prognosis, including effects of antimicrobial use.DATA SOURCES: MEDLINE and Embase databases.STUDY ELIGIBILITY CRITERIA: Quantitative studies reporting microbiological and prognostic data from patients of all age groups presenting with RTI.PARTICIPANTS: Patients presenting to healthcare or research settings with RTI.INTERVENTIONS: Upper respiratory tract swab.METHODS: Systematic review and meta-analysis.RESULTS: Searches identified 5156 articles, of which 754 were duplicates and 4258 excluded on title or abstract. 144 full texts were screened;21 articles retained. Studies reported data for 15 microbes and 26 prognostic measures (390 potential associations). 107 (27%) associations were investigated statistically, of which 38 (36%) were significant. Most studies reported only prognostic value of test positive results. Meta-analyses suggested hospitalisation duration was longer for patients with respiratory syncytial virus than adenovirus and influenza, but significant heterogeneity was observed between studies.CONCLUSIONS: A quarter of potential prognostic associations have been investigated. Of these, a third were significant, suggesting considerable potential for POCT. Future research should investigate prognostic value of positive and negative tests, and interactions between test result, use of antimicrobials and microbial resistance.

KW - Antibacterial

KW - Antimicrobial stewardship

KW - Diagnosis

KW - Point-of-care test

KW - Primary care

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U2 - 10.1016/j.cmi.2019.06.024

DO - 10.1016/j.cmi.2019.06.024

M3 - Review article (Academic Journal)

C2 - 31254715

SN - 1198-743X

VL - 25

SP - 1339

EP - 1346

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

IS - 11

ER -

Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes

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