Nathan J. Brendish, PhD

Credit: University of Southampton

A rapid test for gastrointestinal pathogens for patients with suspected gastroenteritis could help reduce the odds of single-occupancy rooms in the hospital.¹

A team, led by Nathan J. Brendish, PhD, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, evaluated the clinical impact of syndromic molecular point-of-care testing (mPOCT) for gastrointestinal pathogens in adult patients admitted to the hospital with suspected gastroenteritis on single-occupancy room use and a variety of other outcome measures.

Hospital Isolation

Single-occupancy isolation rooms in hospitals are important in preventing the transmission of infectious disease. These types of rooms are utilized for patients with suspected gastroenteritis. However, there are often delays in laboratory testing that result in non-infectious patients remaining in isolation for longer and unnecessary periods of time.

One potential solution to this problem are rapid molecular test panels, where clinicians can test for gastrointestinal pathogens with results available in approximately 1 hour.

However, the clinical impact of this type of test has not previously been explored.

The Study

In the pragmatic, open-label, randomized controlled trial, the investigators examined adult patients in a large hospital in the UK with suspected gastroenteritis. Each patient received either syndromic mPOCT of stool or rectal samples or routine clinical care with laboratory testing.

The investigators sought primary outcomes of the duration of time in single-occupancy rooms assessed on a modified intention-to-treat basis. They also looked at secondary outcomes of the time to results, time to deisolation, antibiotic use, and safety outcomes.

Overall, the investigators assessed 455 patients between March 20, 2017 and March 17, 2020 and ultimately enrolled 278 patients, 138 in the mPOCT group and 140 in the control group. There was 1 withdrawal in the mPOCT group.

The results show the geometric mean duration of single-occupancy room isolation was 1.8 days (95% confidence interval [CI], 1.5-2.2) in the mPOCT, compared to 2.6 days (95% CI, 2.2-3.0) in the control group (exponentiated coefficient, 0.70; 95% CI, 0.56-0.87; P = 0.0017).

In addition, the median time to results for the mPOCT group was 1.7 hours (95% CI, 1.5-2.0), compared to 44.7 hours in the control group (95% CI, 21.2-66.1) (P <0.0001).

The time to deisolation was 0.6 (95% CI, 0.3-1.8) in the mPOCT group, much lower than the 2.2 days (95% CI, 1.2-3.2) in the control group (P <0.0001).

Antibiotics were used in 65% (n = 89) of the mPOCT group, compared to 47% (n = 66) of the control group (P = 0.0028).

Finally, for other outcomes there were no differences between the 2 groups in length of hospital stay or some of the safety outcomes, such as mortality, intensive care unit admission, or hospital readmission.

“mPOCT for gastrointestinal pathogens in patients with suspected gastroenteritis returned results more rapidly than conventional testing and was associated with a reduction in single-occupancy room use,” the authors wrote. “However, these benefits need to be balanced against a potential increase in antibiotic use.”

References:

Brendish, N. J., Beard, K. R., Malachira, A. K., Tanner, A. R., Sanga-Nyirongo, L., Gwiggner, M., Cummings, J. R., Moyses, H. E., & Clark, T. W. (2023). Clinical impact of syndromic molecular point-of-care testing for gastrointestinal pathogens in adults hospitalised with suspected gastroenteritis (gastropoc): A Pragmatic, open-label, Randomised Controlled Trial. The Lancet Infectious Diseases. https://doi.org/10.1016/s1473-3099(23)00066-x