Point-Of-Care Respiratory Diagnosis and Antibiotic Utilization in the Emergency Department: A Prospective Evaluation of Multiplex PCR

Andrew C. Meltzer, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Christopher Payette, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Ryan Heidish, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Isabella Lagunzad, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Aditya Loganathan, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Taylor Bolden, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Michael Friedman, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Matteo Pieri, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
William Huang, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Dominic DeBritz, Virginia Tech University, Blacksburg, Virginia, USA.
Nora Luck, Northwestern University, Evanston, Illinois, USA.
Sean M. Lee, Office of Clinical Research, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Document Type

Journal Article

Publication Date

10-10-2025

Journal

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

DOI

10.1111/acem.70156

Abstract

OBJECTIVES: Rapid multiplex point-of-care (POC) PCR tests may reduce unnecessary antibiotic prescribing by quickly identifying viral etiologies in patients with acute respiratory infections (ARI). We evaluated the impact of a rapid (~15 min) multiplex PCR test on antibiotic prescribing, provider confidence, patient satisfaction, and emergency department (ED) length of stay (LOS). METHODS: We conducted a prospective, single-center study (March 2024-January 2025) enrolling adults presenting to an urban academic ED with ARI symptoms. Participants underwent rapid multiplex PCR testing (BIOFIRE SPOTFIRE Respiratory Panel), with results provided to clinicians in real time. Antibiotic prescribing, provider and patient perceptions, and ED LOS were assessed through surveys and electronic health record review. A propensity-matched control cohort was used to compare antibiotic prescribing and LOS. The primary outcome was antibiotic prescribing among patients with a confirmed viral etiology; secondary outcomes included overall antibiotic prescribing, ED LOS, and provider-and patient-reported measures. RESULTS: A total of 200 patients were enrolled (mean age 43 years; 56.5% female). Common presenting symptoms included cough (80%), congestion (65%), and sore throat (55%). Patients with confirmed viral infections were significantly less likely to receive antibiotics than those with no detected pathogen (6.5% vs. 20.2%; OR 0.28; 95% CI 0.10-0.68; p = 0.009). Overall antibiotic prescribing rates were similar between experimental and control cohorts (14.9% vs. 12.0%; p = 0.392), but median ED LOS was significantly shorter in the experimental group (4.3 vs. 6.5 h; OR 0.66; 95% CI 0.59-0.74; p < 0.001). Provider diagnostic confidence was high (76%), and most patients reported high satisfaction with testing (92%). CONCLUSIONS: Rapid multiplex PCR testing was associated with reduced antibiotic prescribing for viral infections, shorter ED LOS, high provider confidence, and high patient satisfaction. These findings support the value of ultra-rapid diagnostics for antimicrobial stewardship and patient-centered care in the ED.

Department

Emergency Medicine

Link to Full Text

Share

COinS