Influenza or something else

Beep – beep – beep. An elderly patient with a glucose drip inserted into his arm lies on a bed inside a shock room, an area managed by both the hospital’s emergency and ICU staff to stabilize all acutely ill patients. He is being tested for respiratory pathogens, everything from adenovirus to multiple subtypes of parainfluenza. After a nasopharyngeal swab test is taken from the patient, a technician places it into a QIAstat-Dx cartridge. Once the barcode on it is scanned, he carefully loads it into a sleek box the size of a small printer – The QIAstat-Dx.

This small, unassuming machine represents the next generation in multiplex molecular diagnostic systems and can identify over 20 viruses and bacteria in its respiratory panel. Another panel also tests for gastrointestinal pathogens and parasites. Perhaps the most beneficial achievement of this system is that it can determine co-infections and provides results in under an hour.

Dr. Benoît Visseaux, virologist at Bichat hospital and a self-proclaimed “lab guy,” understands firsthand the importance of quickly identifying the causative pathogens in respiratory disease. Each flu season, Visseaux and his team run between 800 and 1000 respiratory tests for the emergency department. He is also currently performing the validation study for the new nCoV assay. Visseaux notes that in the past, doctors never had complete information when starting treatments. “Patients often enter the emergency room with a number of symptoms that don’t allow for a clear diagnosis,” he points out. “A patient might have the flu and be treated unnecessarily for something else, which is costly for the hospital and could result in side effects in the patients.”

Dr. Visseaux calls syndromic multiplex diagnostics like QIAstat-Dx “nothing less than a small revolution.” It merges two key trends in global healthcare: Point of Care testing and Molecular Diagnostics. Experts estimate that it could soon replace frontline test protocols with the reduction of costs and improvement in outcome.

Bringing the lab to the emergency room

Before QIAstat-Dx, when urgent questions arise in the emergency room, the answers were sought elsewhere: In the lab. Visseaux would dispense a sample to the lab via a pneumatic tube system, where results often took hours, sometimes even days, during weekends or holidays, when the lab wasn’t staffed.

As a result of this delay, patients with suspected influenza are often isolated, strictly as a precaution to avoid exposing other patients. For the hospital, this means that beds and rooms are often unnecessarily blocked, or that physicians feel compelled to prescribe antibiotics before any infection is confirmed, which, if unwarranted, can contribute to the rise of antibiotic-resistant bacteria.

With QIAstat-Dx, the lab resides in the emergency room. The machine is small enough to place without getting in the way of hospital staff who need quick access to patients, and is easy for nurses and technicians to use, even with complex, cutting-edge testing taking place within the machine itself. A user needs less than one minute of hands-on time to prepare a sample for this system, which surveys a large number of pathogens, and produces answers fast and onsite, right where they’re needed.

Unexpected Insights

“With QIAstat-Dx we get the results virtually upon the patient’s arrival at the hospital,” says Visseaux. Moreover, “it has also led to some unexpected insights. It used to be, for instance, that the respiratory syncytial virus was thought to be the cause of severe respiratory illness only in children. Such on-the-spot testing has now shown that it lies at the root of many severe infections in adults as well.”

The impressive little system also reduces the quantity of medications prescribed. “It changed our perception, our prescription habits, and it will change the way we work in the future,” says Dr. Celestin Alexis Agbessi, Visseaux’s colleague, while cleaning his classes. Agbessi is convinced that if you change prescription habits and how you think about the patient, you save money, see fewer side effects, use less antibiotics and save time. “In the end,” says Agbessi, “we gain money for both the community and the patients. That is really a big step forward.”