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Benefits and hurdles of rapid testing as point of care

In this video, Dr Kay Roy explores the benefits and hurdles of syndromic testing in the specific context of point-of-care.
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So we’ve discussed the benefits of syndromic testing. Here we’re discussing this one step further by implementing syndromic testing in a point-of-care approach – that’s near-patient approach. And there are obviously further benefits here by delivering results in a much more timelier fashion, even closer to the patient, and also facilitating that decision-making process by the physician looking after the patient. But there are hurdles, too. At a patient level, swift administration of the right antibiotic at the right dose for the right duration for those with significant bacterial infection really, really does improve their outcome. In pneumonia, we know that this is a key performance indicator frequently audited and assessed.
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And conventional methods often take over three days to identify an organism as well as the phenotypic data and sensitivities. And often, less than a quarter of cases are even identified by culture. So there is a huge benefit by ensuring that this treatment is optimised by a quicker approach. But, also, there’s a safety factor here as ensuring that we don’t deliver empirical therapy reduces the incidence of Clostridium difficile. And also, altogether in a population level, at a global level, this is improving antimicrobial stewardship. And we know antimicrobial resistance is a huge global threat.
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There’s a number of initiatives, including the UK five-year plan, to tackle antimicrobial resistance, that advises all antibiotic prescribing is supported by diagnostic tests or decision-making tools by 2024. Earlier identification with syndromic tests and point-of-care tests will help in a hospitalised setting, as well, by identifying extended spectrum beta-lactamases, such as ESBLs, in addition to MRSA and other viruses that we’ve talked about, including influenza, as there is a need to isolate these patients and prevent further transmission and spread. And in the UK, there is a mandatory requirement to report infections, such as Legionella, as well. So earlier sensitive detection is key in all these settings.
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But there are challenges. And if point-of-care systems are to be performed by a patient’s bedside, there needs to be… there is a cost implication, there needs to be training of staff who can provide a service on a 24-hour basis. Expertise is required at a laboratory level to ensure that the results and interpretation cannot be operator dependent. But also, very importantly, we need communication systems that facilitate the results being alerted to the relevant teams – again, on a 24/7 basis. Quality control needs to be considered as ward-based point-of-care systems need to be under the remit of the appropriate laboratory accreditation. Further factors, further kind of barriers to overcome, are around machine maintenance, the technical factors here, interfacing with hospital computer systems.
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And it’s very crucial to ensure test interpretation is the issue of distinguishing colonist and pathogens. And we need to ensure that the results are incorporated into appropriate pathways, patient-based algorithms, and identify where we are going to gain the most benefit from using these platforms – in the community or near the front door in ED? So I wouldn’t say these are barriers, but these are certainly issues to be considered. I’m going to talk very briefly about a community service that I initiated for COPD patients. And this was using the FilmArray from BioFire, but ensuring that we delivered this service in the patient’s home. But measurements were taken in a hospital setting. The samples were taken at the patient’s bedside.
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And this actually facilitated improved antimicrobial stewardship, but also prevented the need for patients to be admitted to hospital, necessarily. But one of the important aspects that we need to consider in addition to all of these is the behavioural aspects, which are crucial in ensuring that, regardless of guidelines and policies, that physicians and healthcare professionals have the confidence to follow these guidelines and to act on the results provided. And ICU decisions, we know, relating to antimicrobial prescribing, in particular, are very multifactorial and complex. And there’s been a number of systemic reviews that identify key factors, including the fear of adverse outcomes, the fear of implications in safety to clinicians if antibiotics are de-escalated.
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And it’s important to be aware of all of these factors in order to ensure the right steps are taken and confidence is ensured. The INHALE trial, outlined earlier, aims to explore aspects around behavioural psychologists and decision-making in ITU care in relation to FilmArray as well as other routine culture methods. So it’s identifying the key intervention points here to optimise stewardship. And so it’s, again, important that we work with the multidisciplinary team to provide confidence here.

In this video, Dr Kay Roy explores the benefits and hurdles of syndromic testing in the specific context of point-of-care.

The cost of running syndromic testing panels as well as training staff to the appropriate laboratory level to prevent operator-dependent interpretation of results is a challenge of implementing syndromic testing. Additionally, IT systems are needed to facilitate the communication of results. Incorporating this testing into the current workflow and ensuring that the quality assurance is under the remit of the appropriate accreditation is an additional challenge.

However, despite the challenges, syndromic testing has multiple benefits. Syndromic testing may be used as a point-of-care test (POCT) to offer a faster turnaround time for results. This quick turnaround time may allow targeted therapy to be given as the first treatment option as determined by the syndromic test, rather than starting the patient on empirical therapy.

Additionally, the identification of microbes — including those not routinely tested for such as viruses — allows more appropriate antimicrobials to be used, thus improving antimicrobial stewardship.

In the next step, Dr Roy highlights how the challenges presented can be overcome by adopting a multidisciplinary approach.

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

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