Point-of-Care Multiplex NAAT for Acute Pharyngitis in the Urgent Care: Detection Patterns, Associated Antimicrobial Prescribing, and Stakeholder Perceptions

Abstract Background Pharyngitis is a frequent cause of urgent care (UC) visits. The SPOTFIRE Sore Throat (SPOTFIRE ST) panel is a CLIA-waived point-of-care test capable of detecting 14 common bacterial and viral pathogens from an oropharyngeal swab. We evaluated detection characteristics, antimicrobial prescribing, and clinician and patient perceptions associated with SPOTFIRE ST testing. Methods We conducted a prospective, single-center study at an academic UC clinic. Eligible participants included 1-2 year-olds with fever, 3-17 year-olds with acute pharyngitis, and adult patients with acute pharyngitis and either immunocompromising or comorbid conditions. Clinical variables were collected, and specimens were tested according to SPOTFIRE ST instructions. Clinicians completed a pre-implementation survey, and clinicians and patients completed a post-implementation survey to assess perceptions and satisfaction with the test. Results At least one detected pathogen occurred in 149/200 (74.5%) patients. Compared to adults, pediatric patients had higher detections (85% vs. 60%, p<0.001), statistically significant higher detections of specifically Group A Streptococcus, influenza B, and M. pneumoniae, and had higher detections of a pathogen with specific antimicrobial treatment (68% vs. 28%, p<0.001). Antibiotics were prescribed in only 7% of cases when a virus was detected. Stakeholders reported high satisfaction with SPOTFIRE ST testing and thought it useful in guiding clinical decisions. Conclusions SPOTFIRE ST testing demonstrated a high proportion of detections with distinct differences between pediatric and adult patients with acute pharyngitis. The detection characteristics and high satisfaction indicate this test is likely to be valued by clinicians and patients and may improve clinical assessment and antimicrobial prescribing. ClinicalTrials.gov identifier: NCT06713642