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

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.