Routine Rapid Multiplex PCR for Respiratory Viruses Improves Inpatient Outcomes

Use of routine rapid sample-to-answer multiplex polymerase chain reaction (PCR) testing in hospitals for respiratory viruses may reduce length of stay and improve influenza infection control management, according to meta-analysis findings published in the Journal of Infection.

Investigators conducted a systematic review and meta-analysis to assess the clinical impact of rapid sample-to-answer multiplex PCR testing for respiratory viruses for patients with possible acute respiratory tract illnesses in a hospital setting.

The reviewers searched MEDLINE, EMBASE, and Cochrane databases from 2012 to present and 2021 conference proceedings for studies comparing the clinical impact and outcomes of standard testing vs rapid sample-to-answer multiplex PCR testing of hospitalized adult suspected of having an ARI. Eligible PCR tests had 10 or more targets. Clinical outcomes included length of stay, infection control facility use, investigations, antibiotic use, time to results, neuraminidase inhibitor (NAI) use, mortality, ancillary testing, provider satisfaction, and patient satisfaction.

Reviewers identified 27 studies with 17,321 patient encounters for meta-analysis (8 randomized controlled trials, 2 controlled clinical trials, 17 observational cohort studies; 12 conducted in the US, 8 in Europe, 3 in Asia, 2 in Argentina, 1 each in Canada and Australia). Baseline characteristics of sex and age were comparable across studies. Risk of bias was low for 5 trials, of some concern in 3 trials, and high in 2 trials; 7 of the 8 journal articles identified were considered of moderate quality and 8 of the 9 conference abstracts were considered low quality.

The researchers found a reduction in time-to-results of -24.22 hours associated with rapid multiplex PCR testing (95% CI, 28.70 to -19.74 hours; I²=98.7%). Rapid multiplex PCR testing was also associated with a decrease in hospital length of stay of -0.82 days (95% CI, -1.52 to -0.11 days; I²=91.9%). Additionally, with use of the rapid multiplex PCR, antivirals were more likely to be given to influenza positive patients (appropriate NAI use expressed as the proportion of influenza-positive patients treated with NAIs; relative risk [RR], 1.25; 95% CI, 1.06-1.48; I²=67.7%) and there was more common infection prevention and control (RR, 1.55; 95% CI, 1.16-2.07; I²=70.4%).

No significant differences in mortality were found between the PCR test group vs the routine testing group overall (RR, 0.82; 95% CI, 0.57-1.18) or within interventional study design subgroups (RR, 1.02; 95% CI, 0.74-1.41) or observational study design subgroups (RR, 0.68; 95% CI, 0.46-1.02). There was no significant difference in 30-day mortality.

Study limitations include substantial statistical heterogeneity, infrequent reports and varying definitions of neuraminidase inhibitor use in the included studies, uncertainty as to whether PCR testing conducted at point-of-care, which could introduce heterogeneity.

“This study shows that the use of rapid sample-to-answer multiplex PCR for detection of respiratory viruses in adults with acute respiratory illness was associated with a large reduction in time to results and a reduction in length of hospital stay compared with routine laboratory-based PCR testing,” said the study authors. Additionally, the study identified an increase in appropriate use of NAIs and infection control facilities with rapid sample-to-answer multiplex PCR testing.

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