According to a recently published single-center study, results obtained from Clinical Laboratory Improvement Amendments (CLIA)-waived point-of-care (POC) polymerase chain reaction (PCR) influenza assays improve prescribing practices of antiviral therapy when compared to results obtained from rapid influenza diagnostic tests (RIDTs).
Because current testing techniques for the diagnosis of influenza possess several drawbacks (lack of sensitivity with RIDTs; performed at centralized laboratories, lengthy time to obtain results with PCR), the study authors aimed to assess the clinical impact of a POC PCR test (the Cobas LIAT Influenza A/B assay) for the diagnosis of influenza. They explained, “We implemented the LIAT assay at 1 urgent care center and compared antimicrobial prescribing for respiratory disease to the other 5 urgent care centers in our system that continued to use POC RIDT for the detection of influenza A and B.”
The study authors reported that prescribing of antiviral agents was lower for patients with a negative result from LIAT PCR (2.3%) compared to RIDT (25.3%; P <.005). Additionally, patients with a positive LIAT PCR result were prescribed antiviral agents more often versus those who had a positive result according to RIDT or reflex PCR (82.4% vs 69.6%, respectively; P <.05). Results of the study also found that more patients who tested negative by LIAT PCR received antibacterial prescriptions compared to patients who tested negative by RIDT (44.5% vs 37.7%, respectively). The authors noted, however, that this difference was not statistically significant.
“In conclusion, having results from a PCR POC test during the clinic visit improved antiviral prescribing practices when compared to having rapid results from an RIDT,” the study authors stated. They added, “The availability of rapid tests with high levels of sensitivity and specificity, enables clinicians to have greater confidence in these timely results, in turn facilitating more appropriate prescribing patterns and overall improved antimicrobial stewardship.”
Robert C. Benirschke, Erin McElvania, Richard Thomson, Karen Kaul, Sanchita Das; Clinical Impact of Rapid Point-of-Care Polymerase Chain Reaction Influenza Testing In An Urgent Care Setting: A Single Center Study;
Journal of Clinical Microbiology Jan 2019, JCM.01281-18; DOI: 10.1128/JCM.01281-18