120 - Impact of a Molecular Point-of-care ‘test and Treat’ Strategy for Influenza in Hospitalised adults: A Multi-centre, Randomised Controlled Trial (FluPOC)

Background: The diagnosis of Influenza in hospitalised patients is delayed due to long turnaround times of laboratory testing, leading to inappropriate and late antiviral and isolation facility use. Molecular point-of-care test (mPOCT) are highly accurate, easy to use and generate results in under 1 hour but high quality evidence for their clinical impact is lacking.

Methods: In this multicentre, randomised controlled trial we enrolled adults hospitalised with acute respiratory illness during influenza seasons. Patients were randomised (1:1) to receive mPOCT for influenza or routine clinical care. The primary outcome was the proportion of influenza-infected patients who received antivirals. Secondary outcomes included time to antivirals, isolation facility use, and clinical outcome. This study is registered with ISRCTN, number:17197293, and has completed.

Results: Between December 2017 and May 2019, 613 patients were enrolled (307 assigned to mPOCT and 306 to routine care) and all were analysed. 100 (33%) of 307 patients in the mPOCT group and 102 (33%) of 306 in the control group had influenza. 100 (100%) of 100 influenza-infected patients were diagnosed in the mPOCT group and 60 (59%) of 102 were diagnosed though routine clinical care (relative risk 1·7, 95%CI 1·7 to 1·7;p< 0·0001). 99 (99%) of 100 influenza-infected patients received antivirals in the mPOCT group versus 63 (62%) 102 in the control group (relative risk 1·6, 95%CI 1·4 to 1·9;p< 0·0001). Median time to antivirals was 1·0 hour in the mPOCT group versus 6·0 hours in the control group (difference of 5·0 hours, 95%CI 0 to 6·0;p=0·004). 70 (70%) of 100 influenza-infected patients in the mPOCT group were nursed in single room accommodation versus 39 (38%) of 102 in the control group (relative risk 1·8, 95%CI 1·4 to 2·4;p< 0·0001). Median hospital recovery scale score (an ordinal 6 point scale used to assess patient outcome) at 7 days was lower in the mPOCT group verses the control group (p=0·045).Figure 1a: Time-to-event curve showing antiviral use over time in influenza-infected patients.
Figure 1b: Time-to-event curve showing isolation facility use over time in influenza-infected patients.


Conclusion: Routine mPOCT for influenza was associated with enhanced influenza detection, improvements in appropriate and timely antiviral and isolation facility use, and more rapid clinical recovery.

Presenting Author(s)

• 

  Tristan William Clark, BM MRCP DTM&H MD

  Associate Professor
  University of Southampton
  Southampton, England, United Kingdom

  Disclosure: BioFire Diagnostics (Other Financial or Material Support, Equiptment and consumables for the purposes of research)BioMerieux (Other Financial or Material Support, Equipment and consumables for the purposes of research)Qiagen (Other Financial or Material Support, Discounted Equipment and consumables for the purposes of research)

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Co-Author(s)

• KB

  Kate Beard, BMBS

  Clinical research fellow
  Universitty of Southampton
  Southampton, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Nathan J. Brendish, MRCP PhD

  NIHR Clinical Lecturer
  University of Southampton & University Hospitals Southampton NHS Trust
  Southampton, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AM

  Ahalya Malachira, MD

  Clinical Research Fellow
  University Hospitals Southampton NHS Trust
  Southampton, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SM

  Samuel Mills, BM BCh

  Clinical Research Fellow
  University Hopsital Southampton Foundation NHS Trust
  Southampton, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• CC

  Cathleen Chan, MBBS

  Clinical Reserach Fellow
  University Hospital Southampton Foundation NHS Trust
  Southmapton, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SP

  Stephen Poole, BMBS

  NIHR (BRC) Clinical Doctoral Research Fellow
  University Hospitals Southampton NHS Trust
  Southampton, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SE

  Sean Ewings, PhD

  Research Fellow
  University of Southampton
  Southampton, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• NC

  Nick Cortes, MBBS

  Consultant in Medical Microbiology
  Hampshire Hospitals Foundation NHS Trust
  Basingstoke, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• EN

  Esther Nyimbili, n/a

  Senior Research Nurse
  NIHR Southampton Biomedical Research Centre
  Southampton, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• LP

  Laura Presland, n/a

  Senior Research Nurse
  NIHR Southampton Biomedical Research Centre
  Southampton, England, United Kingdom

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.