9 August - 2021 infection rates stratified by location of care. In the community setting three studies described decreased antimicrobial use and reduced diagnosable infections following "lockdowns", and this trend persisted even as COVID-19 cases fell potentially due to the associated mitigation measures5,6,7.On the other hand,the high rates of reported hospital acquired bacterial infections in patients admitted for COVID-19 (21-51%) may account for the higher rates of antimicrobial use seen in intensive care settings (65-95%)8,9,10. Unfortunately, the medical community now faces an increased risk of potential outbreaks of multi-drug resistant organisms possibly due to infection control practices, double occupancy rooms, and potentially high rates of antimicrobial use which could persist long after the COVID-19 pandemic.A systematic review by Lansbury L, et al demonstratedthat the overall proportion of COVID-19 patients who had a bacterial co-infection was lower when compared to influenza pandemics.Limitedevidence of S. aureus, S.pneumoniae or S. pyogenesco-infection was present,supporting stopping empirical antibiotics treatments10. Additionalevidence suggeststhat due to low overall rates of bacterial infections, early antimicrobial therapy do not appear to influence patient outcomes11.The Lansbury, et al study also estimated that only 3% of patients hospitalized with COVID-19 were co-infected with another respiratory virus which may be underestimated due to the lower rates of seasonal respiratory viruses seen in 2020 compared to pre-pandemic. It remains to be determined what the next influenza-like illness (ILI) season looks like as social distancing and other protective measures are relaxed. The COVID-19 pandemic has highlighted the indisputable need for accurate, reliable,and time-sensitive diagnostics. Multiplex PCR or syndromic testing has the ability to identify and differentiate amongst >20 respiratory pathogens with a rapid turnaround time of under two hours. A study published early in the COVID-19 pandemic, utilizing a respiratory panel, found influenza accounted for ~30% of COVID-19 suspected cases. The authors concluded that syndromic testing provided an alternative diagnosis which facilitated prompt initiation of antiviral therapy and discontinuation of unnecessary antibiotics12.Respiratory panels have the ability to serve as a powerful tool in the differential diagnosis of patients suspected of COVID-19, in addition to aiding in epidemiological surveillance and public health measures. A respiratory panel can help guide clinical decision-making in both the inpatient and outpatient settings. A rapid and accurate identification of the causative pathogen(s) may provide clinicians more confidence in discontinuing antimicrobial therapy,especially if a non-bacterial pathogen is identified. However, there needs to be a close collaboration between the laboratory and clinician in order to ensure the advanced molecular test results are transmitted and acted upon in real time. Laboratories must work with ASPs to ensure that syndromic panels are implemented appropriately in order to optimize laboratory workflow and maximize clinical outcomes. In the situation where time is of the essence of a diagnosis, such as a critically ill patient, a syndromic panel may aid in ASP efforts, through a faster and comprehensive identification of potential pathogens. However, well-designed, controlled trials are neededto support thehypothesis regardingthe ability of a syndromic respiratory panel to reduce antimicrobial overprescribing. Sonia N. Rao rapid and accurate identification of the causative pathogen(s) may provide clinicians more confidence in discontinuing antimicrobial therapy,especially if a non-bacterial pathogen is identified rapid and accurate identification of the causative pathogen(s) may provide clinicians more confidence in discontinuing antimicrobial therapy,especially if a non-bacterial pathogen is identified
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