Viral Testing May Reduce Antibiotic Use in Severe Lower Respiratory Infection

According to a study published in CHEST, respiratory viral testing is important to improve patient outcomes in adults who have severe lower respiratory tract infections due to viral pathogens. In addition, advanced diagnostic platforms to identify viruses can help patients avoid unnecessary diagnostic testing, reduce antibiotic use, and initiate antiviral therapy.

Researchers examined different testing platforms, many of which have largely automated sample processing and can detect up to 15 pathogens at once. These platforms include serologic testing, conventional tube culture, shell vial culture, rapid antigen detection, polymerase chain reaction technologies, and high-throughput multiplex assays. The researchers concluded that the performance of these testing methods lacked a consistent diagnostic standard and required clinicians to understand each of the different reference standards.

The investigators also reviewed the utility of respiratory viral testing as evaluated in several randomized trials. Trial outcomes generally described increased hospital costs without a reduction in diagnostic procedures, antibiotic use, or length of hospital stay. A common limitation in respiratory viral testing was an inability to distinguish between viral carriage and actual infection, leading to misclassified diagnoses. Additionally, 25% of patients treated for severe respiratory tract infection also tested for bacterial coinfection, and several participants had already received antibiotics at the time of randomization. The researchers suggested this is why recent trials have demonstrated an inconsistent effect of antibiotic use in patient outcomes.

Recognizing that viral pathogens commonly cause severe lower respiratory tract infections and leveraging multiplex high-throughput diagnostic tools can allow clinicians to more accurately identify patients for whom antibiotics are unnecessary and curb antibiotic use.

Disclosures: Dr Wunderink is a consultant to GenMark, bioMerieux, and Accelerate Diagnostics.

Reference

Walter JM, Wunderink RG. Testing for respiratory viruses in adults with severe lower respiratory infection [published online June 13, 2018]. CHEST. doi:10.1016/j.chest.2018.06.003