Table 2.
Outcomes of the studies included in the review.
| Authors and Year of Publication |
N° Patients | Type of Test | Outcomes | NIH Tool | ||||
|---|---|---|---|---|---|---|---|---|
| PR | DOT | LOS | COST | PO | ||||
| Nitsch-Osuch et al., 2017 [8] | 115 | RIDT | Antibiotic therapy was statistically more frequently administered when RIDT was not available (93% vs. 64%; p < 0.05) | Oseltamivir was statistically more prescribed when RIDT was available (64% of patients with influenza received an antiviral, none of the children received an antiviral without RIDT) | FAIR | |||
| Vecino-Ortiz et al., 2018 [9] | 574 | RIDT, rapid VRS test | No significant differences in the antibiotic prescription rate between periods in those positive for influenza and negative for both influenza and RSV | There was no significant difference between the periods for the total length of stay (median = 2 days for both periods, p = 0.23) | Reductions in the average reimbursement charge for patients with a negative influenza and RSV test. No change in reimbursement for patients with proven influenza or RSV infection | Small but significant increase in the cost of drugs between periods 1 and 2 for admissions in which the patients were positive for influenza and/or RSV | FAIR | |
| Abanses et al., 2006 [10] |
1007 | RIDT | Significant reduction in antibiotic prescription in those testing positive for influenza (215 vs. 102, RR 0.85, CI 95% 0.7–1.02) | Time in ED was significantly less in the intervention group (195 vs. 156 min; 95% CI for the difference, 19–60) | Total medical charges were significantly less in the intervention group (USD 666 vs. USD 393; 95% CI for the difference, 153–392) | FAIR | ||
| Diallo et al., 2019 [11] |
241 | RIDT | The mean length of stay in the PED was significantly lower in the positive RDT group: 4.0 h vs. 7.4 h (p < 10−6) | FAIR | ||||
| Noyola et al., 2000 [12] |
1530 | RIDT | Patients discharged from the ED with a positive influenza test were less likely to receive antibiotics than those with a negative test (20% vs. 53%; p < 0.04) Patients admitted to the hospital with a positive EIA test were as likely to receive antibiotics as those without a rapid diagnosis |
Duration of antibiotic administration was significantly shorter in the group with a positive influenza test (3.5 vs. 5.4 days; p = 0.03) | Patients with a positive influenza test were more likely to have a shorter duration of admission than the control group (4.3 mean days versus 7.4; p = 0.02) | Patients with a positive influenza test were more likely to receive antiviral therapy than the control group (25% vs. 0 and 1.8%; p < 0.001) | GOOD | |
| Özkaya et al., 2009 [13] |
97 | RIDT | Patients in group testing prior to prescription were less likely to be prescribed antibiotics when compared to those in the group in which rapid testing was not considered for prescription (32% vs. 100%, respectively, p < 0.0001) | FAIR | ||||
| Bonner et al., 2003 [14] |
391 | RIDT | Reduction in antibiotic prescription in the group in which the results of the rapid test was known in comparison to the group of unknown (7/96 vs. 26/106, p < 0.001); no difference between negative test and negative unaware test (27/97 vs. 27/92, p = 0.0818) | Reduction in the length of stay in the group in which the results of the rapid test were known in comparison to the group of unknown (25 min vs. 49 min, p < 0.001); no difference between the negative test and negative unaware test (45 min vs. 42 min, p = 0.549) | Increase in antiviral prescription in the group in which the results of the rapid test were known in comparison to the group of unknown (18/96 vs. 7/106, p = 0.02); no difference between negative test and negative unaware test (0/97 vs. 2/92, p = 0.236) | GOOD | ||
| Cantais et al., 2019 [15] |
514 | RIDT | Reduction in antibiotic prescriptions, 60 of 245 patients (24.5%) received antibiotics in the DIA negative group, versus 25 of 262 (9.5%) in the positive one (p < 0.001) |
FAIR | ||||
| Iyer et al., 2006 [16] |
700 | RIDT | No significant differences were demonstrated between the POCT and standard test groups with respect to antibiotic prescription | No significant differences were demonstrated between the POCT and standard test groups with respect to lengths of stay | No significant differences were demonstrated between the POCT and standard test groups with respect to visit-associated costs | FAIR | ||
| Jacob et al., 2020 [17] |
1451 | RIDT | Antibiotics were used more in patients with ILI with no RIDT (15.2% in the ILI group vs. 2.7% in the laboratory RIDT group and 11.2% in the ED RIDT group; p < 0.0001) | Patients for whom RIDT was performed at the laboratory had a shorter length of stay when compared to patients for whom RIDT was performed bedside in the ED (4.7 and 5.3 h, respectively; p < 0.0001), | FAIR | |||
| Jun et al., 2016 [18] |
342 | RIDT | Reduction in antibiotic prescription in RAT-positive patients, after the 2009 influenza pandemic (none of the pediatric patients received antibiotics) | The duration of ER stay in discharged patients was 268.9 ± 144.2 min in patients with the use of a RAT kit and 210.5 ± 205.3 min in patients with no use of a RAT kit after the 2009 influenza pandemic | FAIR | |||
| Li-Kim-Moy et al., 2016 [19] | 364 | RIDT | Compared with standard testing (n = 65), children diagnosed by positive POCT (n = 236) had a reduction in antibiotic use (odds ratio 0.42, p = 0.003) | Compared with standard testing, children diagnosed by positive POCT had a shorter median hospital LOS by 1 day (p = 0.006). POCT did not decrease LOS in ED | Compared with standard testing, children diagnosed by positive POCT had increased antiviral prescription (odds ratio 3.1, p < 0.001) | FAIR | ||
| Sharma et al., 2002 [20] |
72 | RIDT | Fewer patients in the early diagnosis group received ceftriaxone sodium compared with the late diagnosis group (2% vs. 24%, p = 0.006) | No significant differences were demonstrated between the POCT and standard test groups with respect to lengths of stay | FAIR | |||
| Patel et al., 2020 [21] |
5307 | RIDT | There was no significant difference in rates of antibiotics used | The median LOS decreased from 239 min in the pre-POC period to 232 min in the post-POC period (p < 0.05) | There were increased rates of oseltamivir used in the post-POC period (21.2% vs. 13.3%, p < 0.05 | FAIR | ||
| Pierron et al., 2008 [22] |
177 | RIDT | There was not any significant difference concerning antibiotic prescriptions | FAIR | ||||
| Benito-Fernandez et al., 2006 [23] | 206 | RIDT | There was a significant reduction in the use of antibiotics (38.5% vs. 0%, p < 0.01) | There was a significant reduction in the mean length of stay in the ED (192.9 versus 116.2 min) (p < 0.01) | FAIR | |||
| Poehling et al., 2006 [24] |
468 | RIDT | There was no difference in antibiotic prescribing | GOOD | ||||
| Jennings et al., 2009 [25] |
16907 | RIDT | Antibiotics were less commonly prescribed for children who were influenza positive by rapid test (3.5% (271/7685) versus 17.2% (125/725) for symptom assessment alone) | The antiviral oseltamivir was prescribed for 24.6% (178/725) of children who were influenza positive by symptom assessment alone and 60.1% (4618/7685) of children who were influenza positive by rapid test | FAIR | |||
| Nitsch-Osuch et al., 2013 [26] |
256 | RIDT | Antibiotics were administered more often in the control group compared with the rapid test group (respectively, for 16% vs. 7%). No child with a positive result of RIDT was prescribed an antibiotic | The antiviral treatment (oseltamivir) was prescribed only for four children with positive results of RIDT | FAIR | |||
| Van Esso et al., 2019 [27] |
1170 | RIDT | Influenza-confirmed patients received fewer antibiotics during the 10 days after influenza diagnosis but not statistically significant compared with the groups with a clinical diagnosis of influenza without a microbiologic confirmation | POOR | ||||
| Cohen et al., 2007 [28] |
602 | RIDT | The antibiotic prescription was overall low (9.5% with RIDT vs. 3.9% without RIDT, p = 0,008), and primarily when the result of RIDT was negative (15.7% if RIDT– vs. 4.3% if RIDT+, p = 0.0003) | The pediatricians using RIDT prescribed with positive tests more oseltamivir (68.5 vs. 1.9%, p < 0.0001) | FAIR | |||
| de La Rocque et al., 2009 [29] |
695 | RIDT | The RIDT+ group received antibiotics in 7.6% of cases, RIDT− in 18.5% (p < 0.0001) | The RIDT+ group received an antiviral in 64.7% and the RIDT− group received no antiviral (p < 0.0001) | GOOD | |||
| Keske et al., 2018 [30] |
258 | FA-RP | Significant decrease in antibiotic use (44.5% in 2015 and 28.8% in 2016, p = 0.009) | The duration of antibiotic use after the detection of virus was significantly decreased in children (p < 0.001) | FAIR | |||
| Kitano et al., 2019 [31] |
1281 | FA-RP | The DOT/case was 12.82 vs. 8.56 (p < 0.001), in the rapid antigen test and mPCR groups, respectively | The LOS was 8.18 vs. 6.83 days (p = 0.032) in the rapid antigen test and mPCR groups, respectively | The total costs during admissions were 258,824 (USD 2331.7) and 243,841 (USD 2196.8)/case, in the rapid antigen test and mPCR groups, respectively | FAIR | ||
| Lee et al., 2020 [32] |
5142 | FA-RP | Patients tested with RP were less likely to receive empiric antibiotics (OR: 0.45; p < 0.001; 95% CI: 0.39, 0.52) compared to RVP patients | Patients tested with RP had a shorter duration of empiric broad-spectrum antibiotics (6.4 h vs. 32.9 h; p < 0.001) compared to RVP patients | RP influenza patients had increased oseltamivir use post-test compared to RVP influenza patients (OR: 13.56; p < 0.001; 95% CI: 7.29, 25.20). | FAIR | ||
| Reischl et al., 2020 [33] |
786 | FA-RP | The binary logistic regression analysis shows no significant (p = 0.784) impact of the FA-RP or the multiplex RT-PCR on the antibiotic treatment | The diagnostic method, FA-RP (8.6 days) or multiplex RT-PCR (9.1 days), showed no significant (p = 0.592) impact on the duration of antibiotic treatment in the linear logistic regression analysis | The mean hospital length of stay for both study groups was 4.7 days. The diagnostic method, FA or multiplex RT-PCR, showed no significant impact on the length of hospital stay in the linear regression analysis. | No significant difference in antiviral prescriptions | FAIR | |
| Schulert et al., 2013 [34] |
790 | FA-RP | The median duration of IV antibiotics for patients with a positive RVP was 55 h, compared with 96 h for patients with a negative RVP (p = 0.03) | The median length of stay for patients with a positive RVP was 3 days, compared with 4 days for patients with a negative RVP (p = 0.057) | FAIR | |||
| Subramony et al., 2016 [35] |
4779 | FA-RP | Subjects in the mPCR group received fewer days of antibiotics than subjects in the non-mPCR group (4 vs. 5 median antibiotic days, p < 0.01) | FAIR | ||||
| Walls et al., 2016 [36] |
237 | FA-RP | A significantly larger proportion of children who had an NPS sample taken (42/146, 36%) received no empiric antibiotics compared to children who did not have a sample taken (7/91, 7.7%, p < 0.001) | Of those who did have an NPS sample taken, 17 of 146 (11.6%) had their antibiotics discontinued prior to or at the time of discharge compared with only 3 of 91 (3.3%) of those who did not have an NPS sample (p < 0.025) | FAIR | |||
| Yoshida et al., 2021 [37] |
181 | FA-RP | We did not observe differences in the use of antibiotics between the pre- and post-mPCR periods (p = 0.14) | We did not observe differences in the duration of antibiotic usage between the pre- and post-mPCR periods (p = 0.45) | We did not observe differences in the length of stay between the pre- and post-mPCR periods (p = 0.94) | FAIR | ||
| McCulloh et al., 2013 [38] |
1727 | FA-RP | Children with a positive RVP test result received antibiotics less often (363 of 703 (51.6%) vs. 71 of 106 (67.0%); p = 0.003) | In total, 21 of 348 (6.0%) children who were positive for a viral pathogen by RVP had antibiotics discontinued within 24 h after RVP test results were available, but no children with negative RVP results had antibiotics subsequently stopped | Children with a positive RVP test result received oseltamivir more often (76.9% vs. 18%; p < 0.001) | FAIR | ||
| McFall et al., 2017 [39] |
176 | FA-RP | Duration of antimicrobial consumption was significantly decreased in patients with a positive FA-RP compared to infants with a negative test (mean rank 2.8 vs. mean rank 5.2 days), p < 0.001) | For all infants with a positive FA-RP result, LOS was significantly decreased compared with infants with a negative FA-RP result (5.7 vs. 10.4 days, p = 0.017) | FAIR | |||
| Iroh Tam et al., 2017 [40] |
1625 | FA-RP | No difference in antibiotic prescription for all types of antibiotics | Patients with a positive test from RVPP had shorter LOS (p = 0.0503) | Hospital charges for patients with a positive test from RVPP were lower, but not significantly so | No difference in antiviral prescription (p = 0.76) | FAIR | |
| Kim et al., 2021 [41] |
915 | FA-RP | FA-RP reduced intravenous (IV) antibiotic use (p = 0.002) | FA-RP reduced the duration of intravenous (IV) antibiotic use, for pediatric patients (p < 0.001) | FA-RP reduced the lead time, waiting time, turnaround time, and length of hospital stay (p = 0.004) | FAIR | ||
| Rogers et al., 2015 [42] |
1136 | FA-RP | The number of patients receiving antibiotics and the inpatient LOS did not differ in the 2 groups | Duration of antibiotic use decreased for patients in the post-FA-RP group by 0.4 days (p = 0.003) | The LOS in the ED increased by 26 min in the post-RRP group (p = 0.002) | FAIR | ||
| Busson et al., 2019 [43] |
142 | FA-RP | Results from the FilmArray Respiratory Panel do not appear to impact antibiotic prescription | The mean length of stay was not significantly different between the two groups (3.9 days for the group with a positive FA result vs. 5.2 days for the group with a negative FA result; p = 0.286) | No difference in oseltamivir prescription | FAIR | ||
| Byington et al., 2002 [44] |
338 | FA-RP | Test-positive patients had fewer discharge prescriptions for oral antibiotics (37% vs. 52%, p = 0.02) when compared with test-negative patients. Intravenous antibiotics were initiated less often for test-positive patients during the second winter season than during the first (26% vs. 44%, p = 0.008) | Test-positive patients had fewer days using intravenous antibiotics (2.4 vs. 4, p = 0.04), fewer days using oral antibiotics (0.25 vs. 2.5, p = 0.04), when compared with test-negative patients | FAIR | |||
| Crook et al., 2020 [45] |
5317 | FA-RP | Following introduction of mPCR testing, the percentage of patients who did not receive antimicrobials increased from 32.4% to 43.1% (difference, 10.8%; 95% CI, 6.5–15%) | Median antibiotic duration decreased by 0.47 days (95% CI, 0.16–0.51) | There was a significant reduction in LOS (p < 0.001) | FAIR | ||
| Dimopoulou et al., 2020 [46] | 80 | FA-RP | The implementation of a rapid molecular test had no impact on antibacterial prescription (10% vs. 13.3%). | The implementation of a rapid molecular test had no impact on antiviral prescription | FAIR | |||
| Rao et al., 2021 [47] |
920 | FA-RP | In the intention-to-treat intervention group (result known), children were more likely to receive antibiotics (relative risk (RR), 1.3; 95% CI, 1.0–1.7) compared to the control group (result not known) | No significant differences in length of stay between the two groups | No significant differences in antiviral prescribing between the two groups | GOOD | ||
| Echavarría et al., 2018 [48] |
156 | FA-RP | Diagnosis with FA-RP was associated with significant changes in medical management including withholding antibiotic prescriptions (OR:12.23, 95%CI:1.56–96.09) | The median LOS was lower for the FA-RP group (4 days) than the control group (10 days) although the difference was not statistically significant (p = 0.382) | Oseltamivir usage was very low and no significant changes in treatment with the drug were observed between the two study groups | GOOD | ||
| May et al., 2019 [49] |
71 | FA-RP | In total, 20 (22%) RP patients and 33 (34%) usual-care patients received antibiotics during the ED visit (–12%; 95% confidence interval, –25% to 0.4%; p = 0.06/0.08) | There was no significant difference in length of ED stay, or hospital stay among admitted patients between the 2 groups | No significant difference in antiviral prescription (+3% (–5% to –10%) 0.53/0.61) | GOOD | ||
| Wishaupt et al., 2011 [50] |
583 | FA-RP | Mean durations of antibiotic treatment, if antibiotic treatment was started, did not differ significantly between the groups | There was a trend toward a shorter length of hospital stay in the intervention group, but the difference was not statistically significant | GOOD | |||
| Beal et al., 2020 [51] |
430 | FA-RP | Appropriate treatment occurred for 93.6% of patients when the FA-RP was performed (Clinic A) versus 87.9% of patients who had only antigen tests performed (Clinic B, p = 0.0445) | Utilization of FA-RP testing also significantly reduced appointment duration time (48.0 versus 54.9 min, p = 0.0009) | Patients tested with FA-RP received less oseltamivir compared to children tested with an antigen test (p = 0.0018) | FAIR | ||
| Thibeault et al., 2007 [52] |
448 | Rapid RSV test | There was no significant difference between children with positive and negative RSV RADT results in the percentage receiving IV antibiotics only (10% versus 7%, p = 0.61); PO antibiotics only (38% versus 28%, p = 0.17); or both PO and IV antibiotics (52% versus 65%, p = 0.12) |
At 24, 48, or 72 h, stopping or switching of IV antibiotics was not influenced by the RADT result in any of the four strata combining age and presence of pneumonia (<3 months and no pneumonia; <3 months without pneumonia; ≥3 months with pneumonia; ≥3 months with- out pneumonia) | FAIR | |||
| Schnell et al., 2017 [53] |
713 | Rapid RSV test | Antibiotic administration within the ED did not differ between those testing positive for RSV versus those testing negative | The mean time in the department was not statistically significant between the 2 groups at 174.1 (SD, 89.8) minutes for the RSV-negative group and 165.2 (SD, 84.6) minutes for the RSV-positive group | FAIR | |||
| O’ Callaghan et al., 2019 [54] |
642 | Rapid PCR for influenza and RSV | 26.3% of positive influenza A/B RSV patients were treated with antibiotics in 2017, whereas 21.3% were treated with antibiotics in 2018 (p = 0.45) | According to time to discharge in the ED, there were no differences between positive and negative patients (p = 0.85) | FAIR | |||
| Mitchell et al., 2018 [55] |
2171 | Rapid PCR for influenza and RSV | Analysis of the post-implementation period revealed a significantly lower percentage (14.3%, p < 0.001) of negative patients receiving antiviral therapy compared to the pre-implementation period, with no difference in prescription of oseltamivir in those testing positive | FAIR | ||||
| Schneider et al., 2018 [56] |
180 | Rapid PCR for influenza and RSV | A positive POCT result significantly reduced antibiotic prescription (p < 0.0011) | A positive POCT result significantly reduced median hospitalization time by 14.2 h for children | FAIR | |||
| Hayashi et al., 2018 [57] |
375 | Mycoplasma PCR | Antimicrobial agents for atypical pathogens (macrolides, tetracyclines, or quinolones) were prescribed in 97.3% (217/223) at the initial evaluation, and their prescription rates increased to 99.1% (221/223) during management | FAIR | ||||
| Ayanruoh et al., 2009 [58] |
8280 | RSTs | Rapid strep testing was associated with a lower antibiotic prescription rate for children with pharyngitis (41.38% for those treated in the pre-RST phase versus 22.45% for those treated in the post-RST phase; p < 0.001) | FAIR | ||||
| Bird et al., 2021 [59] |
605 | RSTs | The baseline prescribing rate was 79%, whereas rates after intervention were 24% in 2015 and 28% in 2016 | FAIR | ||||
| Halverson et al., 2011 [60] |
nd | RSTs | Implementation of POCT was shown to provide a statistically significant drop in LOS of patients who had group A strep testing performed on them, discharging them 25–30 min faster than other patients on average | POOR | ||||
| Kose et al., 2016 [61] |
223 | RSTs | Antibiotic prescription decreased by 42.6% after learning RST results | Antibiotic costs in non-Group A streptococcus pharyngitis, Group A streptococcus pharyngitis, and all subjects’ groups decreased by 80.8%, 48%, and 76.4%, respectively | FAIR | |||
| Małecki et al., 2017 [62] |
1307 | RSTs | Reduction in antibiotic use by 5.1%. | The anticipated cost of treatment decreased by 17% | FAIR | |||
| Maltezou et al., 2008 [63] |
820 | RSTs | Pediatricians without access to laboratory tests were more likely to prescribe antibiotics compared with pediatricians with access to tests (72.2% versus 28.2%, p < 0.001) | FAIR | ||||
| Rao et al., 2019 [64] |
275 | RSTs and PCR Strep A test | The use of POC PCR resulted in the appropriate use of antibiotics in 97.1% of cases compared with 87.5% of cases for the standard of care, RST plus confirmatory bacterial culture (p = 0.0065) | FAIR | ||||
PR = prescription rate; DOT = days of therapy; LOS = length of stay; PO = prescription of oseltamivir; NIH = National Institutes of Health; RIDT = Rapid Influenza Diagnostic Test; FA-RP = Film Array–Respiratory Panel; RSV = Respiratory Syncytial Virus; RSTs = Rapid Streptococcal Tests; PCR = polymerase chain reaction; regarding outcomes, X indicates which outcome is considered in each study; RP = respiratory panel; RVP = respiratory viral panel; NPS = nasopharyngeal swab; RVPP = respiratory virus PCR panel.