Point of care respiratory viral testing (POCT): A novel service to target appropriate antimicrobial prescription and improve antibiotic stewardship

Introduction: Respiratory infections make up a significant proportion of acute admissions with half attributed to viral pathogens. POCT for respiratory viruses allows for rapid diagnosis. This can influence initial treatment decisions, reducing antibiotic-associated morbidity and facilitating early discharge. Aim: To review whether rapid diagnosis of respiratory viruses can a) optimise antibiotic prescribing and b) prevent admission in patients presenting acutely with infective respiratory symptoms. Methods: We have launched the first service-orientated respiratory viral PCOT service (BioFire), in the UK, which provides results from nasopharyngeal swabs within 45 minutes in the emergency department (ED). We present the first 2 weeks data from start of service on 15/01/2018. Results: 130 patients presenting acutely with infective respiratory symptoms were tested. 84 tested positive for viruses (influenza (57), rhinovirus (12), coronavirus (7), metapneumothovirus (5), respiratory syncytial virus (2) and adenovirus (1)). 47 patients who tested positive and had a normal chest radiograph and mean CRP 28.6mg/L (CI 23.5-33.7mg/L), were identified as having no clinical indication for antibiotics. 22 of these were inappropriately prescribed antibiotics. The remaining 25 were discharged safely without readmission. 11 patients who tested positive were safely discharged from the ED without requiring admission. Conclusions: Initial results show potential of this service to inform clinicians to stop antibiotics confidently and avoid admission in a significant number of cases of respiratory viral infection where there is no evidence of bacterial infection.