Rapid point-of-care test for respiratory infections liked by GPs and may reduce antibiotic prescribing

Press release issued: 4 March 2021

A rapid microbiological point-of-care test to diagnose respiratory infections has proved popular with GPs and could reduce antibiotic prescribing in primary care, according to a National Institute for Health Research funded study by researchers at the Centre for Academic Primary Care and NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol.

There are high rates of antibiotic prescribing in primary care and the UK government has called for the introduction of rapid diagnostics to curb overuse.

The RAPID-TEST study, published in the journal Family Practice today [4 March] evaluated the use of the BioFire® Filmarray® v1.7 (bioMérieux) microbiological point-of-care test in four GP practices in the South West of England over a six-week period.

The test uses swabs from the nose and back of the throat and gives results in around 65 minutes. It can detect 17 different types of respiratory virus and three atypical respiratory bacteria. It does not test for the most typical bacteria that cause respiratory infections because these can also live harmlessly in the nose and throat.

The aim of the study was to assess the feasibility of using the test in primary care in preparation for a clinical trial, to find out what GPs and nurses thought about using it, and whether test results changed clinical decisions about diagnosis and treatment.

Of the 93 patients tested (median age 29), 58% had at least one virus, 37% tested negative for any virus or bacteria, 3% had an inconclusive result and 2% had an atypical bacteria. Before the test, clinicians prescribed antibiotics to 35% of patients who, after the test, were found to have no pathogen, and to 25% of patients who, after the test, were found to have a virus, demonstrating the potential of the tests to reduce unnecessary antibiotic prescribing.

The study also found that clinicians changed the diagnosis in one in five patients following testing, and they were more certain of the diagnosis after testing, especially when a virus or bacterium was detected.

During interviews, GPs and nurses said they liked the test and found it easy to use but wanted results faster and to be able to test for typical bacteria.

Alastair Hay, Professor of Primary Care at the Centre for Academic Primary Care, who led the study, said: “Point-of-care tests for multiple respiratory viruses and bacteria are available in the UK but mainly used in hospital settings. Our study is the first to assess the feasibility of their use in primary care. The results show the potential of these tests to improve diagnostic certainty and reduce unnecessary antibiotic prescribing, which is vital in the global fight against antimicrobial resistance.

“This was a small-scale feasibility study and clinical trials are now needed to see if these point-of-care tests can safely and cost-effectively reduce antibiotic prescribing in primary care.”

Lord Jim O’Neill, Chair Chatham House, who led an independent review into antimicrobial resistance in the UK from late 2014 to September 2016, said: “ I have long since believed in quick, affordable, state-of-the-art, point-of-care diagnostics, so I hugely welcome this study and its findings. I hope this unlocks so much more in the area, which is crucial to meeting the challenge of antimicrobial resistance.”

Paper: Novel multi-virus rapid respiratory microbiological point-of-care testing in primary care: a mixed methods feasibility evaluation by Tanzeela Y Kahlid, Lorna J Duncan, Hannah V Thornton, Gemma Lasseter, Peter Muir, Zara Abigail Toney and Alastair D Hay. Published in Family Practice. 4 March 2021.

Listen to the podcast, in which Lord Jim O’Neill interviews Professor Alastair Hay about the study.

Further information

About the Centre for Academic Primary Care
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.

About the National Institute for Health Research
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

funds, supports and delivers high quality research that benefits the NHS, public health and social care
engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.

About the NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at University of Bristol
The NIHR HPRU in Behavioural Science and Evaluation at University of Bristol is one of 14 HPRUs across England, part of a £58.7 million investment by the NIHR to protect the health of the nation. The NIHR HPRU in Behavioural Science and Evaluation is a partnership between Public Health England and University of Bristol, in collaboration with MRC Biostatistics Research Unit at the University of Cambridge and University of the West of England. Each NIHR HPRU undertakes high quality research that is used by PHE to keep the public safe from current and emerging public health threats.