CONTINUING EDUCATION :: RESPIRATORY INFECTIONS AND ANTIMICROBIAL STEWARDSHIP


Additional benefits of syndromic testing to address respiratory infections Syndromic testing is the subject of a growing number of studies, and has been shown to offer benefits to patients, reduce certain healthcare costs, and improve lab efficiency. Particularly for at-risk patients, speed matters. Laboratories can cement re- lationships with ordering physicians and care providers by offering the improved sensitivity and specificity of multiplex PCR testing and deliver accurate results in as little as an hour, instead of 2 or 3 days.18 Across several studies, use of syndromic testing to diagnose


and guide treatment for respiratory infections led to a 13 percent reduction in antibiotic therapy duration,19 in antibiotic prescriptions,20


a 30 percent reduction and one (1.0) fewer days in median


antimicrobial duration in adult influenza patients.21 Mortality and length of stay in intensive care units (ICU) are both reduced by syndromic testing, with one study3


reporting


a three-day reduction in ICU days using multiplex syndromic tests as compared to batch testing and a 10 percent increase in survival when results were reported in less than seven hours. Reinforcing the argument that quality, evidence-based


care saves money, syndromic testing not only reduced ICU bed days, but delivered per patient ICU cost savings of over $9,000 with a positive respiratory pathogen and over $8,000 for a negative result.3 The benefits of syndromic testing for respiratory infections extends into the clinical laboratory, too. Among the significant benefits for labs, is the opportunity to streamline the workflow. One molecular test can provide multiple results so labs can reduce the number of low-plex, microscopy and culture tests ordered. Next, labs can optimize their operations. With less hands-on time and minimal training required, samples can be processed 24 hours a day, seven days a week, without waiting to batch samples. Also, labs were able to deliver a 30.4 hour reduction in turnaround time versus batch testing.22 Not all syndromic panels work the same way, but attractive features to look for include having all reagents preloaded into the cartridge, the ability to perform tests with a single-instru- ment solution, and cartridges that can be shipped and stored at room temperature. Respiratory infections, caused by a wide range of pathogens,


are likely to remain a significant source of illness among humans. As vaccines and treatments emerge to address viral respiratory pathogens, the role clinical laboratories can play is critical in dif- ferentiating what pathogen — bacterial or viral — has made a patient sick. Laboratories can drive the correct diagnosis and the correct treatment, meaning that diagnostic stewardship is a space that clinical laboratories are well positioned to define, underscoring the need for close partnership with front-line healthcare delivery providers, pharmacies, and public health agencies.


REFERENCES


1. Infectious disease: Types, causes & treatments. Cleveland Clinic. Accessed July 19, 2023. https://my.clevelandclinic.org/health/ diseases/17724-infectious-diseases.


2. The top 10 causes of death. Who.int. Accessed July 19, 2023. https:// www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.


3. US Burden of Disease Collaborators, Mokdad AH, Ballestros K, et al. The state of US health, 1990-2016: Burden of diseases, injuries, and risk factors among US states. JAMA. 2018;319(14):1444-1472. doi:10.1001/jama.2018.0158.


4. Trent MJ, Moa A, MacIntyre CR. “I’ll be back”: Australia’s experience of flu in 2022. BMJ. 2022;379:o2998. doi:10.1136/bmj.o2998.


5. Chow EJ, Uyeki TM, Chu HY. The effects of the COVID-19 pandemic on community respiratory virus activity. Nat Rev Microbiol. 2023;21(3):195-210. doi:10.1038/s41579-022-00807-9.


6. Fox AS, Rao SN. Syndromic testing for the diagnosis of infectious dis- eases: the right test if used for the right patient. J Antimicrob Chemother. 2021;76(Suppl 3):iii2-iii3. doi:10.1093/jac/dkab248.


7. de Bellefonds C, Sinha S. COPD: Stay healthy during cold and flu season. Everydayhealth.com. Accessed July 19, 2023. https://www.everydayhealth. com/copd/stay-healthy-during-cold-flu-season/.


8. August. Study: Respiratory viruses easily misdiagnosed without better tests. Los Alamos National Laboratory. Accessed July 19, 2023. https:// discover.lanl.gov/news/0831-respiratory-viruses/.


9. COVID-19: Preparing for the future. Acmedsci.ac.uk. Accessed July 19, 2023. https://acmedsci.ac.uk/file-download/4747802.


10. Testing guidance for clinicians when SARS-CoV-2 and influenza viruses are co-circulating. Cdc.gov. Published February 9, 2022. Accessed July 19, 2023. https://www.cdc.gov/flu/professionals/diagnosis/testing-guid- ance-for-clinicians-hospitaized.htm.


11. Fox AS, Rao SN. Syndromic testing for the diagnosis of infectious dis- eases: the right test if used for the right patient. J Antimicrob Chemother. 2021;76(Suppl 3):iii2-iii3. doi:10.1093/jac/dkab248.


12. Dumkow LE, Worden LJ, Rao SN. Syndromic diagnostic testing: a new way to approach patient care in the treatment of infectious diseases. J Antimicrob Chemother. 2021;76(Supplement_3):iii4-iii11. doi:10.1093/jac/ dkab245.


13. Patel R, Fang FC. Diagnostic stewardship: Opportunity for a labora- tory–infectious diseases partnership. Clin Infect Dis. 2018;67(5):799-801. doi:10.1093/cid/ciy077.


14. CDC. What Exactly is Antibiotic Resistance? Centers for Disease Control and Prevention. Published October 5, 2022. Accessed July 19, 2023. https:// www.cdc.gov/drugresistance/about.html.


15. CDC. U.S. national Action Plan. Centers for Disease Control and Pre- vention. Published June 7, 2022. Accessed July 19, 2023. https://www.cdc. gov/drugresistance/us-activities/national-action-plan.html.


16. Benefits of syndromic testing. Qiagen.com. Accessed July 19, 2023. https://www.qiagen.com/us/applications/syndromic-testing/ syndromic-testing-benefits.


17. Sick WGY. Viruses or Bacteria. Cdc.gov. Accessed July 19, 2023. https:// www.cdc.gov/antibiotic-use/pdfs/VirusOrBacteria-Original-P.pdf.


18. Easy rapid molecular diagnostic tests. Qiagen.com. Accessed July 19, 2023. https://www.qiagen.com/us/applications/syndromic-testing/workflow.


19. Martinez, R.M, et al. Clinical Virology Symposium 2016. Poster #C-368.


20. Zhu C, Sidiki S, Grider B, Fink B, Hubbard N, Mukundan D. A study of the use and outcomes from respiratory viral testing at a mid-sized children’s hos- pital. Clin Pediatr (Phila). 2019;58(2):185-190. doi:10.1177/0009922818809523.


21. Rappo U, Schuetz AN, Jenkins SG, et al. Impact of early detection of respiratory viruses by multiplex PCR assay on clinical outcomes in adult patients. J Clin Microbiol. 2016;54(8):2096-2103. doi:10.1128/jcm.00549-16.


22. US Burden of Disease Collaborators, Mokdad AH, Ballestros K, et al. The state of US health, 1990-2016: Burden of diseases, injuries, and risk factors among US states. JAMA. 2018;319(14):1444-1472. doi:10.1001/jama.2018.0158.


23. Messacar K, Parker SK, Todd JK, Dominguez SR. Implementation of rapid molecular infectious disease diagnostics: The role of diagnostic and antimicrobial stewardship. J Clin Microbiol. 2017;55(3):715-723. doi:10.1128/JCM.02264-16.


Anooj Shah PharmD, MBA, BCIDP is a Medical Science Liaison – Infectious Diseases for QIAGEN North America. A 2018 graduate of Concordia University, Wisconsin, Shah holds his Doctor of Pharmacy and his MBA. He completed two years of post-graduate residency training at Northwestern Medicine in Chicago, specializing in infectious diseases. Prior to joining QIAGEN in 2022, Shah served as a clinical pharmacist focusing


on infectious diseases and antimicrobial stewardship.


Marti Juanola Falgarona, PhD is associate director of Medical Affairs – Infectious Disease for QIAGEN with a focus on syndromic testing and the QIAstat-Dx platform. Juanola-Falgaro- na completed his PhD in 2014 at University Rovira I Virgily, Catalonia, Spain. Prior to joining QIAGEN, Juanola-Falgarona did his Post-Doc at the University of Columbia in New York. During his years in Academia, Juanola-Falgarona has published 21


peer-reviewed publications and several book chapters. MLO-ONLINE.COM SEPTEMBER 2023 | 11


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