{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T07:21:20Z","timestamp":1778224880933,"version":"3.51.4"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T00:00:00Z","timestamp":1581897600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Boston University Social Innovation on Drug Resistance"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Rapid diagnostic tests (RDTs) have been developed with the aim of providing accurate results in a timely manner. Despite this, studies report that provider uptake remains low.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective analysis of ambulatory, urgent care, and emergency department (ED) encounters at an urban safety net hospital with a primary diagnosis of an upper or lower respiratory tract infection (eg, bronchitis, pharyngitis, acute sinusitis) from January 1, 2016, to December 31, 2018. We collected RDT type and results, antibiotics prescribed, demographic and clinical patient information, and provider demographics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>RDT use was low; a test was performed at 29.5% of the 33\u2005494 visits. The RDT most often ordered was the rapid Group A Streptococcus (GAS) test (n\u2005=\u20057352), predominantly for visits with a discharge diagnosis of pharyngitis (n\u2005=\u20055818). Though antibiotic prescription was more likely if the test was positive (relative risk [RR], 1.68; 95% confidence interval [CI], 1.58\u20131.8), 92.46% of streptococcal pharyngitis cases with a negative test were prescribed an antibiotic. The Comprehensive Respiratory Panel (CRP) was ordered in 2498 visits; influenza was the most commonly detected pathogen. Physicians in the ED were most likely to order a CRP. Antibiotic prescription was lower if the CRP was not ordered compared with a negative CRP result (RR, 0.77; 95% CI, 0.7\u20130.84). There was no difference in prescribing by CRP result (negative vs positive).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>RDTs are used infrequently in the outpatient setting, and impact on prescribing was inconsistent. Further work is needed to determine barriers to RDT use and to address potential solutions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaa057","type":"journal-article","created":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T08:48:35Z","timestamp":1581929315000},"source":"Crossref","is-referenced-by-count":4,"title":["Low Uptake of Rapid Diagnostic Tests for Respiratory Tract Infections in an Urban Safety Net Hospital"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6857-6207","authenticated-orcid":false,"given":"Shana A B","family":"Burrowes","sequence":"first","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA"},{"name":"Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alec","family":"Rader","sequence":"first","affiliation":[{"name":"Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pengsheng","family":"Ni","sequence":"first","affiliation":[{"name":"Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mari-Lynn","family":"Drainoni","sequence":"first","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA"},{"name":"Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA"},{"name":"Evans Center for Implementation and Improvement Sciences (CIIS), Boston University School of Medicine, Boston, Massachusetts, USA"},{"name":"Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamar F","family":"Barlam","sequence":"first","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,3,3]]},"reference":[{"key":"2020030809171466500_CIT0001","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1017\/ice.2014.21","article-title":"Antibiotics for respiratory tract infections: a comparison of prescribing in an outpatient setting","volume":"36","author":"Barlam","year":"2015","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2020030809171466500_CIT0002","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jpeds.2018.07.044","article-title":"Variability in antibiotic prescribing for upper respiratory illnesses by provider specialty","volume":"203","author":"Frost","year":"2018","journal-title":"J Pediatr"},{"key":"2020030809171466500_CIT0003","doi-asserted-by":"crossref","first-page":"k5092","DOI":"10.1136\/bmj.k5092","article-title":"Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study","volume":"364","author":"Chua","year":"2019","journal-title":"BMJ"},{"key":"2020030809171466500_CIT0004","doi-asserted-by":"crossref","first-page":"2950","DOI":"10.1128\/JCM.01579-16","article-title":"Clinical utility of on-demand multiplex respiratory pathogen testing among adult outpatients","volume":"54","author":"Green","year":"2016","journal-title":"J Clin Microbiol"},{"key":"2020030809171466500_CIT0005","doi-asserted-by":"crossref","first-page":"i3410","DOI":"10.1136\/bmj.i3410","article-title":"Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records","volume":"354","author":"Gulliford","year":"2016","journal-title":"BMJ"},{"key":"2020030809171466500_CIT0006","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.diagmicrobio.2018.03.018","article-title":"Clinical impact of a rapid streptococcal antigen test on antibiotic use in adult patients","volume":"91","author":"Dodd","year":"2018","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2020030809171466500_CIT0007","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-016-0549-1","article-title":"Exploring the barriers and facilitators to use of point of care tests in family medicine clinics in the United States","author":"Hardy","year":"2016","journal-title":"BMC Fam Pract"},{"key":"2020030809171466500_CIT0008","doi-asserted-by":"crossref","first-page":"636","DOI":"10.5858\/arpa.2014-0257-OA","article-title":"Impact of a rapid respiratory panel test on patient outcomes","volume":"139","author":"Rogers","year":"2015","journal-title":"Arch Pathol Lab Med"},{"key":"2020030809171466500_CIT0009","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ijid.2018.10.003","article-title":"Significance of the detection of influenza and other respiratory viruses for antibiotic stewardship: lessons from the post-pandemic period","volume":"77","author":"Taymaz","year":"2018","journal-title":"Int J Infect Dis"},{"key":"2020030809171466500_CIT0010","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1093\/fampra\/cmx019","article-title":"Diagnostic performance and clinical feasibility of a point-of-care test for respiratory viral infections in primary health care","volume":"34","author":"Bruning","year":"2017","journal-title":"Fam Pract"},{"key":"2020030809171466500_CIT0011","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s40121-015-0087-5","article-title":"Antibiotic discontinuation rates associated with positive respiratory viral panel and low procalcitonin results in proven or suspected respiratory infections","volume":"4","author":"Timbrook","year":"2015","journal-title":"Infect Dis Ther"},{"key":"2020030809171466500_CIT0012","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s10096-017-3174-6","article-title":"The rapid diagnosis of viral respiratory tract infections and its impact on antimicrobial stewardship programs","volume":"37","author":"Keske","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2020030809171466500_CIT0013","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1007\/s10096-013-2003-9","article-title":"Factors associated with the use of rapid antigen diagnostic tests in children presenting with acute pharyngitis among French general practitioners","volume":"33","author":"Michel-Lepage","year":"2014","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2020030809171466500_CIT0014","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1007\/s00431-014-2334-2","article-title":"Virologic testing in bronchiolitis: does it change management decisions and predict outcomes?","volume":"173","author":"Stollar","year":"2014","journal-title":"Eur J Pediatr"},{"key":"2020030809171466500_CIT0015","doi-asserted-by":"crossref","first-page":"e1995","DOI":"10.1002\/rmv.1995","article-title":"Systematic review of the impact of point-of-care testing for influenza on the outcomes of patients with acute respiratory tract infection","volume":"28","author":"Egilmezer","year":"2018","journal-title":"Rev Med Virol"},{"key":"2020030809171466500_CIT0016","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1093\/jpids\/pit073","article-title":"Potential utility of multiplex amplification respiratory viral panel testing in the management of acute respiratory infection in children: a retrospective analysis","volume":"3","author":"McCulloh","year":"2014","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2020030809171466500_CIT0017","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.jmoldx.2017.01.009","article-title":"Impact of rapid molecular respiratory virus testing on real-time decision making in a pediatric emergency department","volume":"19","author":"Rogan","year":"2017","journal-title":"J Mol Diagn"},{"key":"2020030809171466500_CIT0018","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-5172-8","article-title":"Obesity and risk of respiratory tract infections: results of an infection-diary based cohort study","author":"Maccioni","year":"2018","journal-title":"BMC Public Health"},{"key":"2020030809171466500_CIT0019","doi-asserted-by":"crossref","first-page":"e101440","DOI":"10.1371\/journal.pone.0101440","article-title":"Risk factors for acute respiratory infection in the Australian community","volume":"9","author":"Chen","year":"2014","journal-title":"PLoS One"},{"key":"2020030809171466500_CIT0020","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1002\/jmv.25500","article-title":"Prevalence, risk factors and clinical characteristics of respiratory syncytial virus-associated lower respiratory tract infections in Kelantan, Malaysia","volume":"91","author":"Teck","year":"2019","journal-title":"J Med Virol"},{"key":"2020030809171466500_CIT0021","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/S1473-3099(14)70827-8","article-title":"Rapid point of care diagnostic tests for viral and bacterial respiratory tract infections\u2014needs, advances, and future prospects","volume":"14","author":"Zumla","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"2020030809171466500_CIT0022","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1177\/0009922816684602","article-title":"Accurate detection of Streptococcus pyogenes at the point of care using the Cobas Liat Strep A Nucleic Acid Test","volume":"56","author":"Wang","year":"2017","journal-title":"Clin Pediatr (Phila)"},{"key":"2020030809171466500_CIT0023","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jiac.2018.12.005","article-title":"Association between rapid antigen detection tests and antibiotics for acute pharyngitis in Japan: a retrospective observational study","volume":"25","author":"Teratani","year":"2019","journal-title":"J Infect Chemother"},{"key":"2020030809171466500_CIT0024","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1093\/jac\/dks073","article-title":"Perceptions and attitudes of French general practitioners towards rapid antigen diagnostic tests in acute pharyngitis using a randomized case vignette study","volume":"67","author":"Pulcini","year":"2012","journal-title":"J Antimicrob Chemother"},{"key":"2020030809171466500_CIT0025","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1093\/fampra\/cmr031","article-title":"A multi-country qualitative study of clinicians\u2019 and patients\u2019 views on point of care tests for lower respiratory tract infection","volume":"28","author":"Wood","year":"2011","journal-title":"Fam Pract"},{"key":"2020030809171466500_CIT0026","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1093\/ajcp\/aqx081","article-title":"Ensuring the quality of point-of-care testing in a large and decentralized ambulatory care setting","volume":"148","author":"Arboleda","year":"2017","journal-title":"Am J Clin Pathol"},{"key":"2020030809171466500_CIT0027","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1177\/1062860607309626","article-title":"Quality of care in the retail health care setting using national clinical guidelines for acute pharyngitis","volume":"22","author":"Woodburn","year":"2007","journal-title":"Am J Med Qual"},{"key":"2020030809171466500_CIT0028","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1542\/peds.2005-2323","article-title":"Clinicians\u2019 management of children and adolescents with acute pharyngitis","volume":"117","author":"Park","year":"2006","journal-title":"Pediatrics"},{"key":"2020030809171466500_CIT0029","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1007\/s11606-018-4823-x","article-title":"Coding bias in respiratory tract infections may obscure inappropriate antibiotic use","volume":"34","author":"Martinez","year":"2019","journal-title":"J Gen Intern Med"},{"key":"2020030809171466500_CIT0030","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America","volume":"200","author":"Metlay","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2020030809171466500_CIT0031","first-page":"560","article-title":"Acute bronchitis","volume":"94","author":"Kinkade","year":"2016","journal-title":"Am Fam Physician"},{"key":"2020030809171466500_CIT0032","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1177\/0194599815601394","article-title":"Clinical consensus statement development manual","volume":"153","author":"Rosenfeld","year":"2015","journal-title":"Otolaryngol Head Neck Surg"},{"key":"2020030809171466500_CIT0033","doi-asserted-by":"crossref","first-page":"e262","DOI":"10.1542\/peds.2013-1071","article-title":"Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years","volume":"132","author":"Wald","year":"2013","journal-title":"Pediatrics"},{"key":"2020030809171466500_CIT0034","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/S2213-2600(17)30120-0","article-title":"Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial","volume":"5","author":"Brendish","year":"2017","journal-title":"Lancet Respir Med"},{"key":"2020030809171466500_CIT0035","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.jiac.2018.05.006","article-title":"Evaluation of FilmArray respiratory panel multiplex polymerase chain reaction assay for detection of pathogens in adult outpatients with acute respiratory tract infection","volume":"24","author":"Kaku","year":"2018","journal-title":"J Infect Chemother"},{"key":"2020030809171466500_CIT0036","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/j.jpeds.2012.05.001","article-title":"Unrecognized viral respiratory tract infections in premature infants during their birth hospitalization: a prospective surveillance study in two neonatal intensive care units","volume":"161","author":"Bennett","year":"2012","journal-title":"J Pediatr"},{"key":"2020030809171466500_CIT0037","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1007\/s10096-019-03516-z","article-title":"Barriers and facilitators and the need for a clinical guideline for microbiological diagnostic testing in the hospital: a qualitative and quantitative study","volume":"38","author":"Bogers","year":"2019","journal-title":"Eur J Clin Microbiol Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofaa057\/32491061\/ofaa057.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/7\/3\/ofaa057\/32849511\/ofaa057.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/7\/3\/ofaa057\/32849511\/ofaa057.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,3,8]],"date-time":"2020-03-08T13:17:29Z","timestamp":1583673449000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaa057\/5737812"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,1]]},"references-count":37,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaa057","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,3]]},"published":{"date-parts":[[2020,3,1]]},"article-number":"ofaa057"}}