Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Feb 7, 2025
Date Accepted: May 21, 2025
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The impact of point of care testing for influenza on antimicrobial stewardship (PIAMS) in UK primary care: mixed methods study
ABSTRACT
Background:
Influenza and respiratory syncytial virus (RSV) predominantly circulate during the winter season and cause acute respiratory infections (ARI). Deploying molecular point-of-care testing (POCT) in primary care at can inform whether a patient presenting with an ARI has influenza or RSV. An early virological diagnosis, could facilitate appropriate use of antivirals and enable better antimicrobial stewardship.
Objective:
To report the impact of POCT for influenza and RSV on antimicrobial prescribing including antiviral therapy in primary care.
Methods:
The impact of POCT for influenza on antimicrobial stewardship (PIAMS) in UK primary care was an observational study undertaken 20th Jan–31st May 2023, in practices that contribute data to the English sentinel network. People presenting with ARI had nasopharyngeal swab performed and were tested for Influenza and RSV with a molecular POCT analyser located within the practice. Data on antimicrobial prescribing and other study outcomes were collected by linking information from the analyser to coded data from the patient’s computerised medical record (CMR).
Results:
In total 323 swabs were collected from ten PIAMS study practices. 59.7% (197/323) of swabbed patients were female, and the mean age was 37 years. 2.79% (9/323) of all swabs were positive, with 0.31% (1/323) positive for influenza A, 1.55% (5/323) postivie for influenza B and 0.93% (3/323) positive for RSV. In total 80 patients were prescribed antibiotics seven days following POCT testing. There were no instances of antiviral prescribing in the seven days post-testing. The odds ratio for antibiotic prescribing given a positive POCT result was 1.54 (95% CI: 0.38–6.30; P =0.55) compared with a negative test.
Conclusions:
This study illustrates the risk of having a narrow study window, our observation period was not aligned with when influenza was circulating. The peak of weekly incidence of influenza in the sentinel network was in the last week of 2022, and RSV circulating prior to this. Further evidence is needed to assess the impact of POCT on antibimicrobial prescribing. The viruses tested for using POCT could be aligned with the circulating viruses identified by the sentinel network. Clinical Trial: Not applicable
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