Table 2.
Overview of studies reporting on the impact of MRVP on antibiotic use, antiviral therapy and infection control
| Reference | Population | Initial method | Evaluated method | Design | Time to result | Active antimicrobial stewardship? | Effect on antibiotic therapy |
|---|---|---|---|---|---|---|---|
| A. Antibiotic use | |||||||
| [7] | Nonpneumonic LRTI hospitalized adults |
Conventional + duplex PCR influenza/RSV (hospital PCR) |
Initial + PCT + Film Array respiratory Panel (Biofire, Utah, USA) | RCT |
Duplex PCR: 1–2 h after sample received FilmArray: 2–3 h after enrolment |
Yes (text + email providing algorithm) | No significant effect on duration, presumably because of study effect |
| [8] | Adults and children in ED during influenza season | Not applicable | FilmArray respiratory Panel (Biofire, Utah, USA) | Prospective interventional | Not specified | Not specified (results communicated as soon as possible) | No significant effect on antibiotic prescription |
| [9] | Children with positive MRVP | Not applicable | FilmArray respiratory Panel (Biofire, Utah, USA) | Retrospective cohort | 3 h after order entry | Not specified | Longer treatment (> 2 days)/vancomycin more likely in influenza and hMPV positive patients compared to RSV positive patients |
| [10] | Admitted children | rapid antigen test | FilmArray respiratory Panel (Biofire, Utah, USA) | Retrospective | Not specified | No ASP implemented during study period | MRVP contributed to reduction in days of antimicrobial therapy for cephalosporins, macrolides and tetracyclines |
| [11] | Hospitalised adults with positive MRVP | Not applicable | in-house MRVP | Quasi-experimental before and after | Not specified | Yes (by phone in selected patient group with advice) | 1.3-day decrease in mean days of antibiotics postviral diagnosis |
| [12] | Adults in tertiary care referral centre | Not applicable | DFA and MRVP (not specified) | Retrospective observational cohort | Not specified | Not specified | Viral testing was not associated with significant reduction in antibiotic use |
| [13] | Children in tertiary care referral centre | Not applicable | In-house MRVP | Retrospective cohort | Approximately 24 h? | Not specified | Positive result was associated with shorter duration of IV antibiotics for patients with pneumonia/asthma |
| [14] | Adults with respiratory tract infection in tertiary care hospital | Not applicable | In-house MRVP | prospective, non-randomized | 6–24 h | Not specified (results communicated by phone/electronically) |
Antibiotic management was most significantly correlated with radiographic suspicion of pneumonia and less so with results of the MRVP |
| [15] | Children in ED prior to admission or inpatients within first 2 days of admission |
Immunoassay/PCR for influenza and RSV (not specified); DFA for parainfluenza; adenovirus viral culture |
FilmArray respiratory Panel (Biofire, Utah, USA) | retrospective cohort | 2–5 d vs 3 h after order entry | Not specified | Patients tested with MRVP were less likely to receive antibiotics for more than 2 days |
| [16] | Adults in ED and inpatients during influenza season with ILI | Not applicable | In-house MRVP | Retrospective cohort | < 24 h? | Not specified | Unclear impact on antibiotics |
| [17] | Adult inpatients and outpatients | In-house MRVP | FilmArray POC testing (Biofire, Utah, USA) | Quasi-randomised trial | From admission: 39,5 h vs 19 h | No ASP implemented during study period | No difference in mean duration of antibiotics |
| [18] | ED and adult inpatients without pneumonia | Standard MRVP (not specified) | FilmArray POC testing (Biofire, Utah, USA) | RCT | Not specified | Yes (clinical and infection control teams were notified directly + results recorded in medical notes) | More patients received single dose or brief course of antibiotics |
| [19] | Adult outpatients with respiratory tract infection | Delayed in-house MRVP | Rapid in-house MRVP | RCT | After sample collection: 8–12 d vs 24–48 h | Not specified | Reduced antibiotic prescription at initial visit, no effect at follow-up |
| [20] | Adults and children in ED |
IFA (Millipore/ Chemicon, Temecula, CA) |
FilmArray respiratory Panel (Biofire, Utah, USA) | Prospective randomized non-blinded | After sample collection: 26 h vs 1, 52 h | Yes (by telephone and electronic with questionnaire) | Decreased antibiotic prescription |
| [21] | Adults with lower respiratory tract infection without pneumonia | Commercial MRVP (Luminex, Texas, USA) | Rapid respiratory panel (Genmark diagnostics, California, USA) | Retrospective | 12 h–3 d vs 2–4 h | Not specified | Reduced antibiotic initiation in case of positive test for admitted patients without focal radiographic findings |
| [22] | Adult and paediatric inpatients and outpatients with ILI | FilmArray respiratory Panel (Biofire, Utah, USA) | FilmArray respiratory Panel (Biofire, Utah, USA) | Retrospective | After sample collection: a few hours | Yes (training provided) | Decrease in antibiotic use for children. Shorter duration of antibiotic therapy for adults and children after implementation of ASP |
| [23] | ED and inpatient adults positive for respiratory virus | Conventional methods + Influenza/RSV PCR (Gen-Probe, San Diego, USA) + standard MRVP (Luminex, Toronto, Canada) | FilmArray respiratory Panel (Biofire, Utah, USA) | Retrospective cohort | Median TAT for positive influenza: 7, 7 h vs 1, 7 h | Not specified (positive influenza and RSV by telephone) | Influenza positivity was associated with shorter duration of antibiotics |
| [24] | Hospitalized children > 3 months | Influenza/RSV PCR (Focus Diagnostics, California, USA) and PIV1-3 (Hologic, California, USA) | FilmArray respiratory Panel (Biofire, Utah, USA) | retrospective | Mean time: 18, 7 h vs 6, 4 h | Not specified | No difference in whether antibiotics were prescribed, but duration of antibiotic use was shorter after Filmarray implementation |
| [25] | Adults with negative PCT and positive viral PCR | not applicable | FilmArray respiratory Panel (Biofire, Utah, USA) | Pre-post, quasi-experimental study | Not specified | Yes (best practice alert in EMR) | Reduced length of antibiotic use without higher rate for re-initiation after discontinuation |
| [26] | Hospitalized adults | not applicable |
PCR influenza/RSV (Cepheid, California, USA) + eSensor Respiratory viral panel (Genmark diagnostics, California, USA) |
Retrospective quasi-experimental | Not specified | Yes (based on clinical decision support system) | No significant impact on de-escalation or antibiotic use |
| [27] | Patients for which respiratory panel + PCT was performed (age not specified) | Not applicable |
Influenza/RSV first (not specified) + FilmArray respiratory Panel (Biofire, Utah, USA) |
Retrospective | < 24 h | Yes | Decrease in antibiotic duration, most profound with ASP intervention |
| [28] | Hospitalised adults with respiratory panel + PCT | Not applicable | FilmArray respiratory Panel (Biofire, Utah, USA) | Retrospective | < 1 h after specimen obtained | No | Positive MRVP and low PCT results are infrequently associated with discontinuation of antibiotic therapy |
| [29] | Adults in ED | Anyplex II RV16 Detection with delayed results (Seegene, Seoul, Korea) | Anyplex II RV16 Detection with fast results (Seegene, Seoul, Korea) | RCT | After sampling 7 d vs < 24 h (except Friday) | No | No reduction in length of antibiotic therapy |
| [30] | Hospitalized adults with LRTI | routine real-time PCR for ten pathogens (not specified) | FilmArray respiratory Panel (Biofire, Utah, USA) plus routine real-time PCR | RCT | ? vs 1 h after sample collection |
Yes (results were reported and explained to physicians via telephone, text message or face-to-face) |
Shorter duration of intravenous antibiotics. More de-escalation within 72 h and between 72 h and 7 d |
| [31] | Adults in ambulatory cancer center | Not applicable | In-house MRVP, FilmArray respiratory Panel (Biofire, Utah, USA), Inlfuenza PCR (Cepheid) | Retrospective cohort study | About 24 h | Not specified |
Viral testing on day 0 was associated with lower risk of antibiotic prescribing, though collinearity between viral testing and clinical service limited the ability to separate these effects on prescribing |
| B. Antiviral therapy | |||||||
| [8] | Adults and children in ED during influenza season | Not applicable | FilmArray respiratory Panel (Biofire, Utah, USA) | Prospective interventional | Not specified | Not specified (results communicated as soon as possible) | More appropriate prescription of oseltamivir |
| [12] | Adults in tertiary care referral centre | Not applicable | DFA and MRVP (not specified) | Retrospective observational cohort | Not specified | Not specified | Positive sample associated with more antiviral use |
| [14] | Adults admitted for respiratory tract infection in tertiary care hospital | Not applicable | In-house MRVP | Prospective, non-randomized | 6–24 h | Not specified (results communicated by phone/electronically) | Influenza virus positivity was associated with appropriate antiviral management; positivity for viruses other than influenza was not correlated with significantly different outcomes |
| [16] | Adults in ED and inpatients during influenza season with ILI | Not applicable | In-house MRVP | Retrospective cohort | < 24 h? | Not specified | Positive impact on antiviral management for influenza |
| [17] | Adult inpatients and outpatients | In-house MRVP | FilmArray POC testing (Biofire, Utah, USA) | Quasi-randomised trial | From admission: 39, 5 h vs 19 h | No ASP implemented during study period | Decrease in time to first dose of antiviral therapy |
| [18] | Adult ED and inpatients without pneumonia | Standard MRVP (not specified) | FilmArray POC testing (Biofire, Utah, USA) | RCT | not specified | Yes (clinical and infection control teams were notified directly + results recorded in medical notes) | Improved use of neuraminidase inhibitors |
| [20] | Adults and children in ED |
IFA (Millipore/ Chemicon, Temecula, CA) |
FilmArray respiratory Panel (Biofire, Utah, USA) | Prospective randomized non-blinded | After sample collection: 26 h vs 1, 52 h | Yes (by telephone and electronic with questionnaire) | More accurate use of oseltamivir |
| [26] | Hospitalized adults | Not applicable |
PCR influenza/RSV (Cepheid, California, USA) + eSensor Respiratory viral panel (Genmark diagnostics, California, USA) |
Retrospective quasi-experimental | Not specified | Yes (based on clinical decision support system) | Improved time to initiation of oseltamivir |
| [23] | ED and inpatient adults positive for respiratory virus | Conventional methods + Influenza/RSV PCR (Gen-Probe, San Diego, USA) in case of negative rapid antigen test + standard MRVP (Luminex, Toronto, Canada) | FilmArray respiratory Panel (Biofire, Utah, USA) | Retrospective cohort | Median TAT for positive influenza: 7, 7 h vs 1, 7 h | Not specified (positive influenza and RSV by telephone) | Similar rates of antiviral treatment for influenza. Longer median time to first dose for patients with a false negative rapid antigen test |
| [32] | Adult outpatient haemodialysis unit | In-house MRVP | Rapid influenza/RSV PCR (Roche, California, USA) | Retrospective cohort | After sample collection: 22.62 h vs 2.32 h | Positive results for influenza were directly communicated to healthcare provider | Tendency to reduced time of prescription of oseltamivir for influenza |
| [33] | Patients in acute ward, intensive care and paediatric ward | In-house MRVP | Rapid ePlex Respiratory Pathogen Panel (Genmark diagnostics, California, USA) | Retrospective | After sample reception: 27,1 h vs 3,4 h | Not specified (in-house in EMR, rapid by telephone) | More accurate use of oseltamivir |
| C. Infection control | |||||||
| [15] | Children in ED prior to admission or inpatients within first 2 days of admission |
Immunoassay/PCR for influenza and RSV (not specified); DFA for parainfluenza; adenovirus viral culture |
FilmArray respiratory Panel (Biofire, Utah, USA) | Retrospective cohort | 2–5 d vs 3 h | Yes | MRVP testing increased likelihood of isolation for more than 2 days |
| [24] | Hospitalized children > 3 months | Influenza/RSV PCR (Focus Diagnostics, California, USA) and PIV1-3 (Hologic, California, USA) | FilmArray respiratory Panel (Biofire, Utah, USA) | Retrospective | Mean time: 18, 7 h vs 6, 4 h | Not specified | Decreased time in isolation |
| [33] | Patients in acute ward, intensive care and paediatric ward | In-house MRVP | Rapid ePlex Respiratory Pathogen Panel (Genmark diagnostics, California, USA) | Retrospective | After sample reception: 27, 1 h vs 3, 4 h | Not specified (in-house in EMR, rapid by telephone) | Decrease in isolation days in half of the patients |
| [34] | Asymptomatic adult/paediatric haematology and oncology patients | Not applicable | RSV/hMPV r-gene (bioMérieux, Nürtingen, Germany) + RT-PCR influenza A/B | Retrospective data analysis | Not applicable | Electronic with recommendation including alert for infection control team | Additional isolation of asymptomatic patients with positive RSV or influenza test |
| [35] | Hospitalized children | Not applicable | FilmArray respiratory Panel (bioMérieux, Marcy l’Etoile, France) | Partly prospective | Not applicable | Not specified | Results affected infection control management in one-quarter of cases, directly related to number of isolation rooms available |
| [18] | Adult ED and inpatients without pneumonia | Standard MRVP (not specified) | FilmArray POC testing (Biofire, Utah, USA) | RCT | Not specified | Yes (clinical and infection control teams were notified directly + results recorded in medical notes) | Mean time to isolation for influenza positive patients was shorter. Mean time to de-isolation for patients isolated with suspected influenza (but negative test) was shorter |
| [36] | Adult patients with respiratory illness at ED | In-house MRVP | FilmArray respiratory Panel (Biofire, Utah, USA) | After order entry: 36 h vs 3.23 h | Not specified | Isolation measures because of suspected RVI could be prevented in 56% admitted patients | |
| [37] | Hospitalized adults during influenza epidemic | Not applicable | MRVP (not specified) | Retrospective | Not applicable | Not specified | Bed availability became critical and cohorting different viruses was necessary |
| [38] | Adult HSCT patients | Not applicable |
COSMO respiratory-associated virus set targeting HRV, RSV, HCoV, influenza, adenovirus (Maxim Biotech, California, USA) and a combination of primer sets for PIV1-3, hMPV |
Prospective | Not applicable | Not specified |
Real-time monitoring of respiratory viral infections in the HSCT ward among patients with or without respiratory symptoms is required for the prevention of nosocomial RVI, especially of PIV3 infections |
| [39] | Adult haematological patients | Not applicable | Molecular characterization of influenza, PIV and RSV (Qiagen, Hilden, Germany; altona Diagnostics, Hamburg, Germany; Roche, Mannheim, Germany; Fast Track Diagnostics, Luxembourg; Applied Biosystems, Darmstadt, Germany; DNAstar, Madison, USA) | Retrospective | Not applicable | Not applicable | Long-term viral shedding for more than 30 days was significantly associated with prior allogeneic transplantation and was most pronounced in patients with RSV infection with a median duration of viral shedding for 80 days |
| [40] | Children | Not applicable | FilmArray respiratory Panel (Biofire, Utah, USA) + partial sequencing of structural protein gene VP4-VP2 or VP1 region when panel positive for HRV/enterovirus | Not applicable | Not applicable | Not applicable |
Early detection and awareness of emerging infections lead to proactive allocation of resources to manage an impending surge, instead of merely reacting to increased volumes |
ASP antimicrobial stewardship program; CAP community acquired pneumonia; D days; DFA direct fluorescent antibody test; ED emergency department; EMR electronic medical record; h hours; HAP hospital acquired pneumonia; HCoV human coronavirus; hMPV human metapneumovirus; HRV human rhinovirus; HSCT haematopoietic stem cell transplantation; IFA indirect fluorescent antibody test; ILI influenza like illness LRTI lower respiratory tract infection; MRVP multiplexed respiratory viral panel; PCT procalcitonin; PIV parainfluenza virus; POC point-of-care; RCT randomised controlled trial; RSV respiratory syncytial virus; RVI respiratory viral infection; TAT turnaround time; VAP ventilator acquired pneumonia