Impact Of Rapid Diagnostic Tests Research Articles

Rapid diagnostic tests and antimicrobial stewardship programs for the management of bloodstream infection: What is their relative contribution to improving clinical outcomes? A systematic review and network meta-analysis.

Evidence about the clinical impact of rapid diagnostic tests (RDT) for the diagnosis of bloodstream infections is limited, and whether RDT are superior to conventional blood cultures (BC) embedded within antimicrobial stewardship programs (ASP) is unknown. We performed network meta-analyses (NMA) using results from studies of patients with bloodstream infection with the aim of comparing the clinical impact of RDT (applied on positive BC broth or whole blood) to conventional BC, both assessed with and without ASP with respect to mortality, length of stay (LOS) and time to optimal therapy (TOT). Eighty-eight papers were selected, including 25,682 patient encounters. There was an appreciable amount of statistical heterogeneity within each meta-analysis. The NMA showed a significant reduction in mortality associated with the use of RDT + ASP vs BC alone (OR 0.72, 95%CI 0.59, 0.87) and with the use of RDT + ASP vs BC + ASP (OR 0.78 95%CI 0.63, 0.96). No benefit in survival was found associated with the use of RDT alone nor with BC + ASP compared to BC alone. A reduction in LOS was associated with RDT + ASP vs BC alone (0.91, 95%CI 0.84, 0.98) while no difference in LOS was shown between any other groups. A reduced TOT was shown when RDT + ASP was compared to BC alone (-29 h, 95%CI -35, -23), BC + ASP (-18 h, 95%CI -27, -10) and to RDT alone (-12 h, 95%CI -20, -3). The use of RDT + ASP may lead to a survival benefit even when introduced in settings already adopting effective ASP in association with conventional BC.

The impact of rapid diagnostic testing on hospital administrative coding accuracy for influenza.

Hospital administrative coding may underestimate the true incidence of influenza-associated hospitalisation. Earlier availability of test results could lead to improved accuracy of administrative coding. In this study we evaluated International Classification of Diseases 10 (ICD-10) coding for influenza (with [J09-J10] or without [J11] virus identified) in adult inpatients who underwent testing in the year prior, compared to those in the 2.5 years after, the introduction of rapid PCR testing in 2017. Other factors associated with influenza coding were evaluated using logistic regression. Discharge summaries were audited to assess the impact of documentation and result availability on coding accuracy. Influenza was confirmed by laboratory testing in 862 of 5755 (15%) patients tested after rapid PCR introduction compared with 170 of 926 (18%) prior. Following the introduction of rapid testing there was a significant increase in patients allocated J09 or J10 ICD-10 codes (768 of 860 [89%] vs 107 of 140 [79%], P=0.001). On multivariable analysis, factors independently associated with correct coding were rapid PCR testing (aOR 4.36 95% CI [2.75-6.90]) and increasing length of stay (aOR 1.01, 95% CI [1.00-1.01]). Correctly coded patients were more likely to have documentation of influenza in their discharge summaries (95 of 101 [89%] vs 11 of 101 [10%], P<0.001) and less likely to have pending results at discharge (8 of 101 [8%] vs 65 of 101 [61%], P<0.001). The introduction of rapid PCR testing for influenza was associated with more accurate hospital coding. One possible explanation is faster test turnaround leading to improvement in clinical documentation.

Impact of Rapid Identification and Stewardship Intervention on Coagulase-Negative Staphylococcus Bloodstream Infection.

We investigated the impact of rapid diagnostic testing with and without algorithm-based stewardship recommendations on antibiotic use for bloodstream infection with coagulase-negative staphylococci. A significant reduction in antibiotic days of therapy was achieved in the stewardship intervention group that was not seen with rapid diagnostic testing alone.

Antibiotic appropriateness for Gram-negative bloodstream infections: impact of infectious disease consultation

Background We investigated the role of infectious disease consultation (IDC) on therapeutic appropriateness in Gram-negative bloodstream infections (GNBSIs) in a setting with a high proportion of antibiotic resistance. Secondary outcomes were in-hospital mortality and the impact of rapid diagnostic tests (RDTs). Methods Retrospective study on hospitalised patients with GNBSIs. Therapy was deemed appropriate if it had the narrowest spectrum considering infection and patients’ characteristics. Interventional-IDC (I-IDC) group included patients with IDC-advised first appropriate or last non-appropriate therapy. Time to first appropriate therapy and survival were evaluated by Kaplan-Meier curves. Factors associated with therapy appropriateness were assessed by multivariate Cox proportional-hazard models. Results 471 patients were included. High antibiotic resistance rates were detected: quinolones 45.5%, third-generation cephalosporins 37.4%, carbapenems 7.9%. I-IDC was performed in 31.6% of patients (149/471), RDTs in 70.7% (333/471). The 7-day probability of appropriate treatment was 91.9% (95% confidence interval [95%CI]: 86.4–95.8%) vs. 75.8% (95%CI: 70.9–80.4%) with and without I-IDC, respectively (p-value = 0.0495); 85.5% (95%CI: 81.3–89.1%) vs. 69.4% (95%CI: 61.3–77.2%) with and without RDTs, respectively (p-value = 0.0023). Compared to RDTs alone, the combination with I-IDC was associated with a higher proportion of appropriate therapies at day 7: 81.9% (95%CI: 76.4–86.7%) vs. 92.6% (95%CI: 86.3–96.7%). At multivariate analysis, I-IDC and RDTs were associated with time to first appropriate therapy [adjusted hazard-ratio 1.292 (95%CI: 1.014–1.647) and 1.383 (95%CI: 1.080–1.771), respectively], with no impact on mortality. Conclusions In a setting with a high proportion of antibiotic resistance, IDC and RDTs were associated with earlier prescription of appropriate therapy in GNBSIs, without impact on mortality.

1826. Comparative Use of Vancomycin versus Ampicillin for Blood Stream Infections Caused by Ampicillin-susceptible Enterococcus faecalis

Abstract Background Available studies assessing the efficacy of beta-lactam antibiotics compared to vancomycin (VAN) in the treatment of Enterococcal blood stream infections (BSI) have varying results and have not assessed the impact of rapid diagnostic testing. We aimed to compare clinical outcomes of ampicillin (AMP) vs. VAN for E. faecalis BSI treatment. Methods A multisite, retrospective evaluation of adults with E. faecalis BSI between 2017 to 2021 was performed. Patients who received at least four days of AMP or VAN as definitive therapy were analyzed; only initial episodes were included. All positive blood cultures underwent multiplex polymerase chain reaction blood culture identification (BCID). Patients with polymicrobial BSI were excluded, or if they received ≥ 50% concomitant use of AMP and VAN. The primary outcome was 30-day all-cause mortality. Secondary objectives included 90-day all-cause mortality, hospital length of stay, incidence of treatment failure, persistent BSI, change from initial definitive therapy, and adverse drug reactions (ADRs). Other microbiology endpoints included time to active treatment, BCID, beta-lactam coverage, definitive therapy, and culture clearance. A sample size of 208 patients was estimated to provide a 15% mortality difference with 80% power. Results In total, 123 patients with E. faecalis BSI were analyzed (AMP, n = 92; VAN, n = 31). Baseline characteristics were similar among both groups except gender and baseline penicillin allergy (p &amp;lt; 0.001) (Table 1). All-cause 30-day mortality was not significantly different between patients treated with AMP and VAN (10.8% vs. 22.6%, p = 0.130). No difference was found in secondary objectives except time to definitive therapy was longer for the AMP treatment arm (56.7 hours vs. 15.8 hours, p &amp;lt; 0.001) (Table 2). The incidence of ADRs were similar between the two groups (Table 3). Conclusion No difference in mortality was observed in the treatment with AMP or VAN for patients with E. faecalis BSI, but the study was not sufficiently powered. Despite the use of rapid BCID testing, earlier initiation of AMP was not observed. AMP or VAN may be reasonable options for treatment of E. faecalis BSI, but further research is warranted. Disclosures All Authors: No reported disclosures.

Diagnostic Stewardship-The Impact of Rapid Diagnostic Testing for Paediatric Respiratory Presentations in the Emergency Setting: A Systematic Review.

Antimicrobial resistance is a growing public health crisis, propelled by inappropriate antibiotic prescription, in particular the over-prescription of antibiotics, prolonged duration of antibiotic therapy and the overuse of broad-spectrum antibiotics. The paediatric population, in particular, those presenting to emergency settings with respiratory symptoms, have been associated with a high rate of antibiotic prescription rates. Further research has now shown that many of these antibiotic prescriptions may have been avoided, with more targeted diagnostic methods to identify underlying aetiologies. The purpose of this systematic review was to assess the impact of rapid diagnostic testing, for paediatric respiratory presentations in the emergency setting, on antibiotic prescription rates. To review the relevant history, a comprehensive search of Medline, EMBASE and Cochrane Database of Systematic Reviews was performed. Eighteen studies were included in the review, and these studies assessed a variety of rapid diagnostic testing tools and outcome measures. Overall, rapid diagnostic testing was found to be an effective method of diagnostic antibiotic stewardship with great promise in improving antibiotic prescribing behaviours. Further studies are required to evaluate the use of rapid diagnostic testing with other methods of antibiotics stewardship, including clinical decisions aids and to increase the specificity of interventions following diagnosis to further reduce rates of antibiotic prescription.

Modelling the impact of rapid diagnostic tests on Plasmodium vivax malaria in South Korea: a cost–benefit analysis

BackgroundRapid diagnostic tests (RDTs) are widely used for diagnosing Plasmodium vivax malaria, especially in resource-limited countries. However, the impact of RDTs on P. vivax malaria incidence and national medical costs...

How are rapid diagnostic tests for infectious diseases used in clinical practice: a global survey by the International Society of Antimicrobial Chemotherapy (ISAC)

Novel rapid diagnostic tests (RDTs) offer huge potential to optimise clinical care and improve patient outcomes. In this study, we aim to assess the current patterns of use around the world, identify issues for successful implementation and suggest best practice advice on how to introduce new tests. An electronic survey was devised by the International Society of Antimicrobial Chemotherapy (ISAC) Rapid Diagnostics and Biomarkers working group focussing on the availability, structure and impact of RDTs around the world. It was circulated to ISAC members in December 2019. Results were collated according to the UN human development index (HDI). 81 responses were gathered from 31 different countries. 84% of institutions reported the availability of any test 24/7. In more developed countries, this was more for respiratory viruses, whereas in high and medium/low developed countries, it was for HIV and viral hepatitis. Only 37% of those carrying out rapid tests measured the impact. There is no ‘one-size fits all’ solution to RDTs: the requirements must be tailored to the healthcare setting in which they are deployed and there are many factors that should be considered prior to this.

The impact of rapid diagnostic testing, surveillance software, and clinical pharmacist staffing at a large community hospital in the management of Gram-negative bloodstream infections

Rapid diagnostic testing (RDT) combined with an antimicrobial stewardship program (ASP) has shown improved outcomes in bloodstream infections (BSIs). We assessed the impact of RDT, surveillance software, and ASP pharmacist staffing on time to optimal therapy (TOT) in Gram-negative BSIs. Adults with Gram-negative BSIs were included in this retrospective evaluation across 2 study periods. The preimplementation group (n = 121) had longer TOT than the postimplementation group (n = 120) (59.6 ± 36.2 h versus 29.0 ± 24.2 h, P < 0.001). Escalation (51.1 ± 26.4 h versus 16.9 ± 15.7 h, P < 0.001) and de-escalation (63.1 ± 39.5 h versus 39.2 ± 25.6 h, P < 0.01) of therapy were shorter in the postimplementation group. TOT for patients with multidrug-resistant organisms (MDROs) was shorter in the postimplementation group (61.8 ± 37.2 h versus 21.9 ± 18.8 h, P < 0.001). TOT was shorter during fully staffed clinical pharmacist hours (30.6 ± 58.9 h versus 19.7 ± 31.7 h, p = 0.014). Implementation of RDT and surveillance software with an ASP decreased TOT for Gram-negative BSIs, including MDROs.

Impact of Peptide Nucleic Acid Fluorescence in Situ Hybridization Testing for Coagulase-Negative Staphylococci in a Pediatric Setting

Background Coagulase-negative staphylococci (CoNS) are common blood culture contaminants, whereas Staphylococcus aureus is a pathogen with isolation from blood requiring therapy. Peptide nucleic acid fluorescence in situ hybridization (PNA-FISH) permits distinction of CoNS and S. aureus and has been demonstrated to decrease hospital costs, vancomycin use, and length of stay when paired with antimicrobial stewardship intervention. The impact of this testing in a children's hospital in the absence of stewardship intervention is unknown. The objective of this study was to determine the impact of PNA-FISH in a setting without an antimicrobial stewardship protocol for response to rapid testing. Methods This retrospective cohort study included pediatric patients with at least 1 CoNS-positive blood culture between January 1, 2012, and August 1, 2016. Patients were categorized based on the use of Staphylococcus QuickFISH, a rapid PNA-FISH method of identification. The primary outcome was hours of vancomycin exposure. Secondary outcomes included time-to-therapy change, time to culture result, and hospital length of stay. Results Of the 211 identified patients who had at least 1 blood culture bottle positive for CONS, 179 (85%) received vancomycin. Median hours of vancomycin exposure decreased between groups (63 rapid diagnostic testing group vs 81 conventional testing group; P = 0.019). Conclusions Despite an observed decrease in vancomycin exposure with use of rapid PNA-FISH testing, the full benefits of rapid diagnostic testing are unrealized in the absence of an appropriate stewardship protocol. Further studies may allow determination of the full impact of rapid diagnostic testing in pediatric settings.

Ideal and Actual Impact of Rapid Diagnostic Testing and Antibiotic Stewardship on Antibiotic Prescribing and Clinical Outcomes in Children With Positive Blood Cultures.

Implementing matrix-assisted laser desorption ionization-time of flight and multiplex polymerase chain reaction has been associated with decreased mortality and hospital length of stay in adults, but the impact in pediatrics is less understood. This pre-post quasi-experimental study compared antibiotic prescribing for positive blood cultures in patients ≤21 years of age collected in 2012 (preintervention) and in 2015 (after matrix-assisted laser desorption ionization-time of flight/multiplex polymerase chain reaction). Time to effective and optimal antimicrobial therapy was evaluated using Cox proportional hazards regression. Time to ideal optimal therapy was estimated as the earliest potential initiation of optimal therapy. Antibiotic use and clinical outcomes were measured. There were 242 and 192 positive monomicrobial blood cultures in 2012 and 2015, respectively. Postintervention, time to optimal therapy (73.8 vs. 48.8 hours; P < 0.001) and organism identification (55.6 vs. 29.5 hours; P < 0.001) were reduced, and patients were more likely to receive optimal therapy by 7 days (hazard ratio, 1.85; P < 0.001). In the ideal scenario in 2015, there was an 8.8-hour delay in initiating optimal therapy based on the time that sufficient microbiologic data were available. Postintervention, time to effective therapy (2.8 vs. 2.7 hours; P = 0.782) and clinical outcomes did not differ. Unnecessary antibiotic duration for probable contaminants (skin flora) (43.1 vs. 29.7 hours; P = 0.027), vancomycin for methicillin-sensitive Staphylococcus aureus (54.0 vs. 41.3 hours; P = 0.008) and nonpenicillin/ampicillin antibiotics for group A Streptococcus, group B Streptococcus and Enterococcus faecalis (87.2 vs. 33.4 hours; P < 0.001) were reduced postintervention. Rapid diagnostics reduced time to optimal antimicrobial therapy and unnecessary antibiotic use without worse clinical outcomes.

Impact of rapid diagnostic tests on the management of patients presenting with Enterobacteriaceae bacteremia

ObjectivePathogens are usually identified from blood cultures using a two-step procedure: Gram staining on the day of bacterial growth (D0), followed by identification and susceptibility testing the following day (D1). We aimed to evaluate the use of rapid tests performed on D0 in patients presenting with Enterobacteriaceae bacteremia. Patients and methodsPatients with≥1 positive monomicrobial blood culture with Gram staining suggestive of an Enterobacteriaceae were prospectively included. Two successive strategies were evaluated: i) conventional strategy (CS), ii) combination of a rapid identification test and third-generation cephalosporin susceptibility testing (rapid strategy, e.g. RS). ResultsEighty-three patients were included (CS=42; RS=41). Compared with CS, the median delay of identification was significantly shorter with RS (22 hours [20–27] vs. 47 hours [42–53]; P<0.001). Patients in the RS group more frequently received an effective (82.9% vs. 73.8%, P=0.43) and appropriate (70.7% vs. 54.7%, P=0.17) antibiotic therapy on D1. Moreover, all five RS patients infected with a non-susceptible strain received an effective therapy on D1 versus only three of eight CS patients. ConclusionsUse of rapid testing was associated with a reduced time to result availability. This strategy should be useful to initiate an early effective and appropriate therapy and to improve the care of patients.

1807. The Impact of Rapid Diagnostic Testing and Antimicrobial Stewardship on the Time to Escalation/De-escalation of Antimicrobial Regimens for Gram-Negative Bloodstream Infections at a Large Community Hospital

BackgroundPrompt identification of an etiologic pathogen is vital for the optimal management of bloodstream infections (BSIs). Rapid diagnostic testing (RDT) has implications for the treatment of BSIs, particularly for cases with resistant Gram-negative (GN) organisms. The purpose of this study was to assess the impact of Verigene’s Gram-negative blood culture nucleic acid test (BC-GN), in conjunction with a pharmacy-driven antimicrobial stewardship team (AST), on time to antimicrobial optimization in GN BSIs.MethodsThis was a retrospective pre- and post-intervention study at a 950-bed community hospital in South Texas. Clinical isolates from adult patients with GN BSIs were included across two study periods: from July 1, 2012 to July 31, 2014 in the pre-intervention group (prior to BC-GN with AST) and from July 1, 2015 to July 31, 2017 in the post-intervention group (after BC-GN with AST). RDT results were transmitted to pharmacy-managed surveillance software for AST review and intervention. The primary outcome was time to optimal therapy (TOT) from initial culture positivity. Secondary outcomes included TOT based on organism and clinical pharmacy staffing hours, hospital length of stay, and all-cause mortality.ResultsAmong 324 patients screened with a first episode of GN BSI, 121 and 119 patients were included in the pre- and post-intervention groups, respectively. Apart from intensive care unit admission at the time of culture collection, there were no significant differences in baseline characteristics between the two groups. The post-intervention group had a significantly shorter TOT (60.2 ± 36.0 hours vs. 29.0 ± 24.0 hours, P < 0.001). Notably, time to escalation for patients with third-generation cephalosporin-resistant isolates was significantly shorter in the post-intervention group (48 ± 36.0 hours vs. 19.2 ± 16.8 hours, P < 0.01). In the post-intervention group, TOT was significantly shorter during fully staffed clinical pharmacy hours vs. reduced clinical pharmacy staff hours (18.48 ± 31.2 hours vs. 31.44 ± 38.4 hours, P = 0.014). No differences were seen in length of stay or all-cause mortality.ConclusionThe implementation of RDT with a pharmacy-driven AST substantially decreased TOT for GN BSIs. This study also highlights the positive impact of clinical pharmacy staff on shorter TOTs.Disclosures All authors: No reported disclosures.

A systematic review of the economic impact of rapid diagnostic tests for dengue

BackgroundDengue fever is rapidly expanding geographically, with about half of the world’s population now at risk. Among the various diagnostic options, rapid diagnostic tests (RDTs) are convenient and prompt, but limited in terms of accuracy and availability.MethodsA systematic review was conducted of published data on the use of RDTs for dengue with respect to their economic impact. The search was conducted with combinations of key search terms, including “((Dengue[Title]) AND cost/economic)” and “rapid diagnostic test/assay (or point-of-care)”. Articles with insufficient report on cost/economic aspect of dengue RDTs, usually on comparison of different RDTs or assessment of novel rapid diagnostic tools, were excluded. This review has been registered in the PROSPERO International prospective register of systematic reviews (registry #: CRD42015017775).ResultsEleven articles were found through advanced search on Pubmed. From Embase and Web of Science, two and 14 articles were obtained, respectively. After removal of duplicate items, title screening was done on 21 published works and 12 titles, including 2 meeting abstracts, were selected for abstract review. For full-text review, by two independent reviewers, 5 articles and 1 meeting abstract were selected. Among these, the abstract was referring to the same study results as one of the articles. After full text review, two studies (two articles and one abstract) were found to report on cost-wise or economic benefits of dengue RDTs and were selected for data extraction. One study found satisfactory performance of IgM-based Panbio RDT, concluding that it would be cost-effective in endemic settings. The second study was a modeling analysis and showed that a dengue RDT would not be advantageous in terms of cost and effectiveness compared to current practice of antibiotics prescription for acute febrile illness.ConclusionsDespite growing use of RDTs in research and clinical settings, there were limited data to demonstrate an economic impact. The available two studies reached different conclusions on the cost-effectiveness of dengue RDTs, although only one of the two studies reported outcomes from cost-effectiveness analysis of dengue and the other was considering febrile illness more generally. Evidence of such an impact would require further quantitative economic studies.

A Retrospective Study of the Impact of Rapid Diagnostic Testing on Time to Pathogen Identification and Antibiotic Use for Children with Positive Blood Cultures.

IntroductionRapid identification of bloodstream pathogens provides crucial information that can improve the choice of antimicrobial therapy for children. Previous impact studies have primarily focused on adults. Our objective was to evaluate the impact of rapid testing in a children’s hospital on time to organism identification and antibiotic use in the setting of an established antimicrobial stewardship program.MethodsWe conducted a retrospective study over three consecutive time periods (spanning January 2013–August 2015) as our hospital sequentially introduced two rapid testing methods for positive blood cultures. An antimicrobial stewardship program was active throughout the study. In the baseline period, no rapid diagnostic methods were routinely utilized. In the second period (PNAFISH), a fluorescent in situ hybridization test was implemented for gram-positive organisms and in the third a rapid multiplex PCR (rmPCR) test was employed. For children with positive blood cultures, time to organism identification use and duration of select antimicrobial therapies were compared between periods.ResultsPositive blood cultures were analyzed. Median overall time to organism identification was 23, 11, and 0 h in the baseline, PNAFISH, and rmPCR periods, respectively (p < 0.001 for both PNAFISH and rmPCR vs. baseline). For gram-negative organisms, only rmPCR performed significantly faster than baseline (p < 0.001). The duration of vancomycin use for coagulase-negative staphylococci was shorter in both the PNAFISH and rmPCR periods (mean 31 h in the baseline period, 12 and 14 h in the PNAFISH and rmPCR periods, respectively). For MSSA bacteremia, use of vancomycin was significantly decreased only in the rmPCR period (32% of patients vs. 64 and 72% in the baseline and PNAFISH periods; mean duration of 9 h vs. 30 and 26 h). There was no difference in use or duration of broad-spectrum gram-negative therapy across the three time periods.ConclusionRapid diagnostic testing for children with positive blood cultures results in faster time to identification and can influence antibiotic prescribing in the setting of active antimicrobial stewardship particularly for gram-positive pathogens.FundingMerck.

Impact of Rapid Diagnostic Testing on Antibiotic Prescribing in Hospitalized Children With Positive Blood Cultures

Impact of Rapid Diagnostic Testing on Antibiotic Prescribing in Hospitalized Children With Positive Blood Cultures

Impact of rapid diagnostic testing for chlamydia and gonorrhea on appropriate antimicrobial utilization in the emergency department

Prolonged turnaround time of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) test results may delay time to notification and treatment of test-positive patients and result in unnecessary antimicrobial use in test-negative patients. This quasi‐experimental study evaluated the impact of NG/CT rapid diagnostic testing (RDT) in an urban emergency department (ED) on treatment appropriateness, time to notification, and cost. Patients tested in December 2013–January 2014 (traditional group, n=200) were compared with those in December 2014–January 2015 (RDT group, n=200). There was a significant increase in treatment appropriateness in the RDT group, 72.5% versus 60% (P=0.008) and time to results notification was significantly faster (median 17.4 versus 51.5hours, P=0.010). Availability of test result prior to discharge was associated with increased treatment appropriateness (odds ratio, 22.65 [95% confidence interval, 2.86–179.68]). The RDT would save approximately $37,000 annually. These results support the use of NG/CT RDT to expand antimicrobial stewardship efforts within the ED.

Impact of New Diagnostic Approaches for Invasive Candidiasis on Antifungal Stewardship

Invasive candidiasis (IC) including candidemia and deep-seated candidiasis is associated with up to 50 % overall mortality and up to $80,000 in attributable cost (2015 US$). Rapid diagnostic tests (RDTs) for Candida have been developed. However, whether RDTs along with real-time decision support translate to better attainment of stewardship goals—improve clinical outcomes, minimize unintended consequences of antifungal use, and reduce healthcare costs—is unknown. The purpose of this systematic review was to provide an up-to-date review of recently published studies that have assessed how RDTs for IC impact attainment of these goals. Three electronic bibliographic databases were searched using a pre-defined search strategy evaluating the impact of RDTs for IC on attainment of antifungal stewardship goals. Quality assessments were performed by two reviewers using established study methodology metrics. Eight studies were identified of which five had sufficient information to be included in the review. Despite the limitations of the various studies and the different methodologies employed, the studies all produced similar conclusions. Compared to conventional methods and baseline stewardship activities, the integration of RDTs for IC and real-time decision support, mainly through antifungal stewardship, was associated with decreased mortality, more optimal use of antifungals, and reduced healthcare costs. However, larger clinical studies are needed to confirm these trends.

Impact of Rapid Diagnostic Testing on Time to Identification and Antibiotic Use for Children With Positive Blood Cultures

Impact of Rapid Diagnostic Testing on Time to Identification and Antibiotic Use for Children With Positive Blood Cultures

Impact of rapid diagnostic tests for the diagnosis and treatment of malaria at a peripheral health facility in Western Uganda: an interrupted time series analysis.

BackgroundThe World Health Organization recommends that all suspected malaria cases receive a parasitological diagnosis prior to treatment with artemisinin-based combination therapy. A recent meta-analysis of clinical trials evaluating RDTs for the management of patients with fever found substantial reductions in anti-malarial prescriptions when health workers adhered to treatment protocols based on test results. However few studies have reported on the impact of RDTs on health systems outside research settings.MethodsThe study comprised a retrospective interrupted time series analysis, comparing rates of malaria diagnosis, treatment, and resource utilization before and after introduction of RDTs at a peripheral health facility in rural Western Uganda. The use of malaria diagnostic tests was graphically depicted throughout the study period and fit regression models to identify correlates of three outcomes of interest: (1) length of stay (2) the proportion of patients referred to a higher-level health facility, and (3) administration of antibiotics.ResultsOver the course of the study period, 14,357 individuals underwent diagnostic testing for malaria with either a RDT (9,807) or microscopy (4,550). The proportion of patients with parasite-based diagnoses more than tripled to 34 % after the introduction of RDTs. RDTs largely replaced microscopy as the diagnostic method of choice. Compared to patients admitted during the pre-RDT period, patients admitted to the health centre with malaria in the post-RDT period had significantly reduced odds of being referred to another health centre (AOR = 0.49, P = 0.038), receiving antibiotics (AOR = 0.42, P < 0.001), and a significantly shorter mean length of stay (β = −0.32 days, 95 %CI −0.52 to −0.13).ConclusionsThis study is one of the few to demonstrate significant improvement in clinical outcomes and process measures following the introduction of RDTs for the diagnosis of malaria at a rural health facility in Uganda. The results show a reduction in referrals and shorter mean inpatient LOS even as antibiotics were prescribed less frequently. This change greatly increased laboratory throughput and the resultant proportion of patients receiving a parasite-based diagnosis.