Novel multi-virus rapid respiratory microbiological point-of-care testing in primary care: a mixed methods feasibility evaluation

Tanzeela Y Khalid, Lorna J Duncan, Hannah V Thornton, Gemma Lasseter, Peter Muir, Zara Abigail Toney, Alastair D Hay*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background and objectives 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). Methods 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. Results Twenty clinicians recruited 93 patients (estimated 1:3 of all RTI cases). Patient’s median age was 29, 57% female, and 44% with comorbidities. 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. Conclusions This POCT was acceptable and appeared to influence clinical reasoning. Clinicians wanted faster time-to-results and more information about bacteria. Randomised trials are needed to understand safety, efficacy, and patient perceptions of these POCTs.
Original languageEnglish
Article numbercmab002
Number of pages8
JournalFamily Practice
Early online date4 Mar 2021
DOIs
Publication statusE-pub ahead of print - 4 Mar 2021

Keywords

  • bacterial
  • diagnosis
  • point-of-care testing
  • primary health care
  • respiratory tract infections
  • viral

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