A-363 Comparison of comprehensive syndromic versus limited respiratory panel results in a point-of-care setting

Abstract

Background Syndromic multiplex molecular point-of-care (POC) tests boast high sensitivity and short turnaround times, supporting prompt diagnosis and informed treatment decisions at the time of patient visit (Lucar 2024). The family of BIOFIRE® SPOTFIRE® Respiratory/Sore Throat (R/ST) Panels are such tests with options for a comprehensive syndromic panel (R/ST Panel) and a condensed menu panel (R/ST Mini) limited to five viral pathogens: Influenza A and B viruses, human rhinovirus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The comprehensive R/ST Panel has four additional viral pathogens, the ability to subtype influenza A/H1-2009 and A/H3, and four atypical bacterial pathogens (see Figure 1). When utilizing these types of POC tests appropriately, positive results can reduce antibiotic use, increase appropriate antiviral prescriptions, and may reduce hospitalization time (Schneider 2020, Egilmezer 2018). These outcomes ultimately improve diagnostic stewardship by eliminating the need for serial or individual testing. This analysis demonstrates how the respiratory menu for R/ST Panel Mini and the comprehensive R/ST Panel can increase diagnostic yield. Methods Deidentified patient test results were captured by BIOFIRE® FIREWORKS™ Trends (Trends), a cloud-based pathogen surveillance network for BIOFIRE® systems. Results were limited to 01/01/2025 to 01/31/2026 for the comprehensive R/ST Panel with the nasopharyngeal sample type. The diagnostic yield for all pathogens on the R/ST Panel was compared to the theoretical diagnostic yield for a subset of pathogens present on the R/ST Panel Mini over the course of 2025. Peak pathogen activity was also summarized and compared over time. Results During respiratory season, detection of R/ST Panel Mini pathogens were highest with an average diagnostic yield of 51.8%, and lowest during the late spring and summer months (diagnostic yield = 43.3%). In contrast, the R/ST Panel with all pathogens results in a diagnostic yield of 65.5% during the respiratory season and 56.8% during spring and summer months. The three most common pathogens identified on the comprehensive R/ST Panel that are not included on the R/ST Panel Mini include parainfluenza virus, seasonal coronaviruses, and adenovirus, with >2,500 detections from each virus. Many of these detections occur in the late spring and early summer, after the peak influenza season. Conclusion When respiratory virus transmission is high and contextual and/or operational constraints exist, the SPOTFIRE® R/ST Panel Mini detects five common respiratory viruses, which supports rapid clinical decision-making for patient treatment and management. In the months outside of respiratory season, the comprehensive syndromic SPOTFIRE® R/ST Panel improves diagnostic yield by 14% on average (range: 5% - 22%). The comprehensive SPOTFIRE® R/ST Panel therefore offers robust syndromic testing in a point-of-care setting, which may reduce the need for additional follow ups, improving diagnostic stewardship and patient management.