Adults hospitalised with diarrhoea are routinely isolated as an infection control measure, but many have non-infectious aetiology. Side room facilities are a limited resource in hospitals. Routine laboratory testing takes several days to generate results but rapid molecular platforms can test comprehensively for GI pathogens and generate a result in 1 hour, making them deployable as point-of-care tests (POCT). POCT could reduce unnecessary isolation facility use in addition to other benefits.
In this pragmatic, pilot randomised controlled trial, adults hospitalised with suspected gastroenteritis were recruited and randomised 1:1 to receive either POCT (using the FilmArray GI panel) or routine clinical care. Results of POCT were communicated directly to clinical and infection control teams. The primary outcome was duration of time in a side room and secondary outcomes included turnaround time, proportion of patients with a pathogen detected, proportion of patients correctly de-isolated, time to de-isolation, antibiotic use and length of hospital stay.
140 patients were recruited. Groups (n=70) were well matched in terms of baseline characteristics. The median [IQR] turnaround time for results was 1.7 [1.6-2.3] hours in the POCT group and 61 [49-84] hours in the control group, p<0.0001. Pathogens were detected in 44% of patients in the POCT group and 23% in the control group; p=0.012. Overall the duration of side room isolation was 1.9 [1.0-2.9] days in the POCT group compared to 2.7 [1.8-5.1] days in the control group; p=0.001. For those testing negative for pathogens this was 1.3 [0.8-2.5] days in the POCT group versus 2.7 [1.8-5.0] days in the control group, p<0.0001. 63% of pathogen-negative patients were correctly de-isolated in the POCT group versus 28% in the control group, p=0.0012. Antibiotic use and length of stay data will be available subsequently.
POCT using the FilmArray GI panel resulted in a substantially reduced turnaround time for results and an increase in the proportion of patients with pathogens correctly detected. POCT was associated with a reduction in the duration of unnecessary side room use. If these benefits are confirmed in further studies and cost effectiveness is demonstrated, molecular POCT for GI pathogens should replace current diagnostic pathways.
N. Brendish, None
T. Clark, BioFire LLC: Collaborator , Research support and Speaker honorarium . NIHR: Grant Investigator , Grant recipient .