Rapid Influenza Diagnostic Testing May Improve Antibiotic Resistance

Point-of-care rapid influenza diagnostic tests (RIDTs) in urgent care facilities may help guide treatment decisions and improve patient outcomes while minimizing antibiotic resistance. These study results were published in Clinical Infectious Diseases.

Researchers analyzed data collected from another study to determine patients’ ability to accurately self-collect nasal swab specimens for RIDT. Patients with acute respiratory infections (ARI) received bilateral RIDT testing at 2 urgent care facilities from February 7, 2019, to May 13, 2019, and from November 1, 2019 and March 4, 2020. The results of the RIDT were sent to the treating clinician during the appointment within 15 minutes.

Testing was performed using the influenza A+B fluorescent immunoassay. Participants’ electronic medical records were reviewed following testing to evaluate the results and the medications ordered. A retrospective analysis of the non-RIDT-tested cohort of International Statistical Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes was used as the control cohort.

The primary outcome was the differences in antibiotic or antiviral prescribing behavior. The researchers used t-tests to compare the ages of both cohorts, and a Chi-squared test was used to compare the sexes of each cohort.

In the RIDT-tested cohort, participants were primarily women (55.7%) with a mean age of 31.00 years. In the non-RIDT cohort, participants were primarily women (55.7%) with a mean age of 31.07 years.

Participants who were RIDT-positive were more likely to be prescribed antivirals (odds ratio [OR], 10.23; 95% CI, 5.78-19.72; P <0.0001) than antibiotics (OR, 0.15; 95% CI, 0.08-0.27; P <0.0001). Those in the RIDT-positive cohort had increased odds of receiving antivirals (OR, 28.21; 95% CI, 18.15-43.86; P <0.0001) and decreased odds of receiving antibiotics (OR, 0.20; 95% CI, 0.13-0.30; P <0.0001) compared with those in the RIDT negative cohort. Compared with participants in the non-RIDT cohort, those in the RIDT-positive cohort had a 923% increase in the odds of receiving antivirals (OR, 10.23; 95% CI, 5.78-19.72; P <0.0001).

Limitations of the study include the use of diagnostic codes that do not match symptoms and the sample size not being varied. Comorbid conditions were also not analyzed.

The researchers conclude, “ Implementation of RIDTs could provide clinicians information to improve their diagnostic and prescribing practice, benefit patients by reducing the burden of unnecessary testing, increase efficiency and reduce costs for urgent care centers, assist in mitigating the burden of influenza at the population level, and help confront the spread of antibiotic resistance.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. This research was supported by Quidel Corporation. Please see the original reference for a full list of disclosures.