Table 7.

Narrative Summary of Studies Including Patients with a Variety of Respiratory Illnesses; Comparison: Routine PCR versus Rapid PCR Viral + Bacterial Testing

Author, Year (Reference)	Study Design	Setting/Participants	Key Results
Andrews et al., 2017 (28)	Quasirandomized trial with patients enrolled in the control arm on odd days of the month and enrolled in the intervention arm on even days of the month; the control consisted of in-house multiplex PCR for viruses, and the intervention consisted of a POC multiplex PCR panel for 17 viral and 3 bacterial targets	545 patients, ≥16 yr of age, seen in both inpatient and outpatient settings, with symptoms suggestive of an URTI, ILI, or LRTI; no data regarding number with suspected pneumonia	There was no significant difference in the hospital LOS between the control and the intervention. The median hospital LOS was 79.6 h (IQR, 41.9 to 188.9 h) in the control arm and 98.6 h (IQR, 48.1 to 218.4 h) in intervention arm. Comparing the control arm with the intervention arm, no significant difference was detected in antibiotic use at any time during the hospital stay after enrollment or in duration of antibiotic use. Among patients with influenza, the time to the first dose of antiviral therapy was shorter in the intervention arm: median of 60.4 h in the control arm (IQR, 22.7 to 85.2 h) vs. median of 24 h in the intervention arm (IQR, 11.6 to 33.0 h).
Mercuro et al., 2018 (29)	Single-center, quasiexperimental study evaluating antimicrobial use after implementation of an in-house multiplex PCR panel for 17 viral and 3 bacterial targets coupled with an antimicrobial stewardship audit	131 hospitalized, immunocompromised patients were tested with a respiratory viral panel (send-out testing, n = 51; compared with in-house testing, n = 75); pneumonia was diagnosed in 80 (61.1%) patients	Compared with send-out testing, the in-house multiplex panel did not significantly alter antimicrobial optimization interventions (30.7% vs. 35.7%) but did reduce the time to intervention from specimen collection from 52.1 to 13.9 h (P < 0.001). There was no significant difference between these groups for type of antimicrobial intervention (deescalation, discontinuation, or addition), hospital LOS, or empiric antibiotic duration.
Shengchen et al., 2019 (30)	Single-center, open-label randomized trial with patients randomized to POC testing with a multiplex PCR panel for 17 viral and 3 bacterial targets plus routine PCR or to routine PCR for 10 viral pathogens	800 hospitalized patients (398 in the intervention group and 402 in the control group) with LRTI; 57% had received a final diagnosis of pneumonia	No significant difference was observed between the two groups regarding the proportion of patients given i.v. antibiotics (92.1% vs. 93.8%; 95% CI, −5.1% to 2.0%; P = 0.38). The median duration of i.v. antibiotic treatment in the intervention group was significantly shorter than that in the control group (7 vs. 8 d, 95% CI, −2.1 to −0.8 d; P < 0.001). More patients in the intervention group had antibiotic deescalation within 72 h (7.9% vs. 3.2%; 95% CI, 1.4% to 8.0%; P = 0.005) than in the control group. The median hospital LOS was significantly shorter in the intervention group than in the control group (8 vs. 9 d; 95% CI, −1.6 to −0.4 d; P < 0.001).

Definition of abbreviations: CI = confidence interval; ILI = influenza-like illness; IQR = interquartile range; i.v. = intravenous; LOS = length of stay; LRTI = lower respiratory tract illness/infection; POC = point of care; URTI = upper respiratory tract infection.