Real-world impact of point-of-care testing for SARS-CoV-2 in an ambulatory setting of an integrated health network

Objective: Point-of-care testing (POC) is an important tool for diagnosing SARS-CoV-2. This objective of this study was to evaluate the real-world performance of rapid molecular (rPCR) and rapid antigen (rAg) methods and their impact on antibiotic prescribing. Methods: We retrospectively analyzed adult patients tested for SARS-CoV-2 at outpatient clinics within an integrated health network from December 2021 to March 2023 to determine antibiotic use in settings where POC testing for SARS-CoV-2 were deployed. Patients were included if their initial test was with rPCR or rAg. We conducted a 3:1 propensity score matching analysis to compare rPCR and rAg testing outcomes. Univariate and multivariate logistic regression analyses were used to identify predictors of antibiotic use within 24 hours of a positive test. Results: Of 104,364 patients that underwent testing with a rapid test in the ambulatory setting, 24,133 (29.0%) tested positive for SARS-CoV-2. Molecular testing had the highest percent positive compared to antigen testing (26.2% vs 20.8%). Overall, antibiotics were prescribed to 10% of positive cases, with higher rates following rAg testing (13% vs 10%, P < .001). Chronic lung disease (OR: 1.4 [1.2–1.7], P < .001) and white non-Hispanic race (OR: 1.5 [1.1–2.1], P = .014) were associated with an increased odds of receiving antibiotics while a rPCR test (OR: 0.8 [0.7–1.0], P = .03) was associated with a significantly decreased odds or receiving antibiotics. Conclusions: POC molecular testing outperformed antigen testing in SARS-CoV-2 detection and was associated with lower antibiotic prescribing, supporting its role in antimicrobial stewardship.