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The value of Syndromic testing to patient care

In this video Dr Kay Roy addresses the value syndromic testing holds for patient care, analysing its benefits in the context of respiratory infections
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Hello, everyone. My name’s Kay Roy. I’m a consultant respiratory physician at University College London, and thank you very much for your attention. So my slant is going to be more on respiratory infections, but this is – hopefully the discussion that will arise from this will really be applicable to many other kind of emergency admissions with patients with infection in the acute setting. So why is it timely? Well, the current pandemic has really focused on the importance of viruses, which really didn’t get such a big forum in the past. But we can see the kind of evolving landscape that we’re living in. Viruses are very much there on the horizon as something to look out for.
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But also, the co-infection of bacteria and viruses, the interaction of these organisms is something we have to be mindful of – but also to be mindful of the population that we’re looking after, where we look after patients now who are on a number of different biological therapies, who are now host to a range of different organisms. And we’re in a kind of healthcare climate where there is a growing pressure on our systems globally to deliver care in a timely fashion, but this means empowering our physicians, our healthcare professionals at the frontline to deliver and act upon tests in a point-of-care setting, which is also something we will raise.
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And it’s all amidst this ever-looming threat that we have of antimicrobial resistance and our need to deploy these methods and combat this on an international scale. So what do we need? We need tests that are delivered quickly, easily, reliably in order to tackle these issues and focus on ensuring best patient care. And this hopefully will translate in a reduction of number of tests that a patient needs with syndromic testing, almost serving a one-test-serves-all approach, and ensuring direct therapy of antibiotics, but also antivirals – and improving the use of our hospital facilities, reducing unnecessary hospital stays, and the pressure that this has on the healthcare systems at large.
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Overall, going from a patient level, hopefully this will actually equate to an overall health economic benefit altogether. So lots of important things to talk about. So acute respiratory infection has always been a huge burden of disease. It’s in the top three up there as a common cause of mortality worldwide. And modern molecular diagnostics have shown that viruses – respiratory viruses – are detectable in up to 50% of hospitalised patients with respiratory infection. But as soon as they come through the front door, they’re usually empirically prescribed antibiotics and hospitalised, often for intravenous delivery.
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And these are in clinical groups in which viruses are strongly implicated as the cause, and there’s no actual evidence for benefit in delivering antibiotics here, such as patients with an exacerbation of asthma or COPD. There’s a lot of diagnostic uncertainty around the microbial aetiology which is contributing to this practice in care, and a lot of initiatives in the UK are trying to focus on ensuring that more direct therapy is endorsed. There’s a potential benefit of having a point-of-care molecular system here to reduce this unnecessary practice, and reduce harm.
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So syndromic testing has allowed us to understand a lot more about the phenotypic characteristics of a patient, but also population at large, and how viruses are impacting on the environment, and how this can exacerbate disease behaviour. So we’re aware of the importance of isolating patients now for a range of viruses, not just influenza – so looking beyond that. Although we’re not in an influenza season at the moment, and it’s kind of been overlooked somewhat, we can’t forget that there have been influenza outbreaks that have led to death, and the importance of a timely and rapid diagnosis of flu ensures that we do deliver antivirals within that first 48 hours of symptom onset without delay, which will actually limit virus transmission.
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And again, it will ensure that patients aren’t given antibiotics unnecessarily. So viral source has to be considered in number of both upper and lower respiratory tract infections, such as pneumonia. And if we look at the conventional laboratory methods compared to syndromic from a post hoc study by ResPOC by Clark et al. in Southampton, shows that a rapid turnaround time of less than two hours, almost around 1 and 1/2 hours, is very important in achieving that window of care to actually reduce unnecessary antibiotics and improve that clinical decision-making for early discharge, discontinuing antibiotics, and also preventing unnecessary hospital admission. So this whole essence of delivering results in a speedy fashion, reliable fashion is vital.
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Although there are point-of-care tests which are based on rapid technologies, if the sensitivity is low, as there are for some testing panels just for influenza, again, there needs to be an element of caution applied here, as it’s important to ensure that we do have the sensitivity and specificity that is delivered with high sensitivity syndromic panels. So rapid identification of viruses, of bacteria also is crucial to prevent the transmission to other vulnerable groups within the hospital, especially the immunocompromised inherently vulnerable nature of some of the patients admitted to emergency care.
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There’s been numerous efforts that have shown that point-of-care PCR can improve the social distancing practices and curb these nosocomial infection spreading, cohorting patients based on pathogen. And this really transforms patient flow and reduces the risk which has been recommended by the World Health Organisation. So rapid virus detection can improve these triaging decisions at the front door – the closer to the front door, the better – and ensure that patients aren’t at risk to each other. We’re more and more aware of this now, with the current pandemic, but even looking previously at influenza, there is that need to mitigate infection transmission for all viruses.
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And we know with metapneumoviruses, which is becoming more common now in the United States, a lot more viruses emerging where we do need to employ these kind of cohorting measures, not just restricted to influenza and COVID. So we can see the value of syndromic testing here. We can see how important this is from a patient level, but also to a population level at large – improving antimicrobial stewardship, ensuring adequate infection control measures are in place – as we can detect with good sensitivity, the organism, or the virus maybe, causing disease, but also protecting healthcare workers and other patients, and improving patient flow. Thank you.

In this video, Dr Kay Roy addresses the value syndromic testing holds for patient care, analysing its benefits in the context of respiratory infections. Respiratory infections can be caused by viral and/or bacterial pathogens; syndromic testing panels exist for both viral and bacterial targets, as well as AMR gene targets which can be useful in assessing antimicrobial susceptibility and guiding treatment decisions.

Today, increasing focus is being placed on the importance of viruses in causing disease. Additionally, it is important to consider the impact of co-infection of viruses and bacteria, and their interactions, on management — especially in patient populations undergoing immunotherapy and hosting different organisms.

Syndromic testing adds value in the form of quick, reliable tests resulting in: a reduction of the number of tests needed, directed antibiotic and antiviral therapy, improved use of hospital facilities, a reduction in unnecessary hospital stays, and the stress this places on healthcare systems. For the patient, this results in improved care.

The reference cited in the video has been provided as a link in the see also section.

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Syndromic Testing and Antimicrobial Stewardship

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