Could nasopharyngeal swab tests be used to detect bacteria?

If you’ve read my posts in the past, you’ve read about my disappointment and frustration with not being given a sputum test earlier in the process before a final diagnosis of BE. Others have echoed a similar belief.

I’d never been given a nasal swab to detect a bacterial infection, even when doctors have felt it was appropriate to give as many as three antibiotics and even steroids to try to clear an infection. There was no effort to try to determine the type bacteria to target an antibiotic treatment.

Has anyone else had this experience?

It seems counterproductive because insurance companies want to keep costs down but spending a few dollars on a swab test -either nasal or sputum - would limit antibiotic use, perhaps prevent chronic disease and obviously save the system money in the long run. Patients would certainly benefit, although some might argue big pharma have a stake in the status quo. More likely it is reflective of busy doctors following their own protocols established years before. What would be the take from Medical teaching hospitals on the use of the simple swab testing to detect bacteria?

I don’t bash big pharma, after all those companies are creating the antibiotics that help us.

Just curious if any studies have been done to look at analyzing the use of swab testing in primary care offices or hospitals to look at prevention of more acute infection and chronic disease. Just wondering if this would be considered worthwhile?

This seems like a good idea, but a "simple" nasal swab has a couple of complications. I would like to offer this for your consideration:

Your nose is the barrier that traps debris and germs - nasal swabs can give "positive" results based on what has recently been trapped there from your environment. Therefore what is found isn't necessarily what is causing infection in your sinuses, lungs, throat and elsewhere.

Patient resistance - just ask any provider how hard it is to get someone to allow them or their nurse or assistant to put a swab up the nose, then ask them to wait 3-7 days for an answer. Most people want to walk out the door with a prescription in hand because they feel lousy today.

Provider experience - providers who see dozens of patients a day know with 90% or more certainty what will work in most cases. Throat swabs are frequently used in the case of a sore throat, because without them it is difficult to differentiate strep from virus. My providers do swab my skin or sinuses (OUCH!) if the first round doesn't work. Last year I had 3 staph infections on wounds, after round one of antibiotics, even the Urgent Care doc willingly swabbed to get the right antibiotic.

Sputum cultures are another situation - PCP's have little experience with them, and in some clinical settings do not even have the right codes to order them because they usually have to go to an outside lab and can be very costly.

As an informed patient with risk factors, I do advocate for myself and you should too, but we probably won't see a wholesale change in practice.

Thanks @sueinmn Yes, I’ve only had two nasal swabs done in 2021/2022 or so. Not pleasant but thankfully, no Covid!

Yes, when most physicians provide it, patients will gladly take an antibiotic when not feeling well. We’ve all been there. I just think the tests, especially sputum tests ( when there are other ongoing symptoms) would be helpful in getting to an earlier diagnosis, when the first antibiotic doesn’t work.

Time and money are two important factors in healthcare.

PCR respiratory panels are rapid and expensive but very beneficial in a serious respiratory distress. Some are only for viruses while others include bacteria for Whooping cough, Chlamydia and mycoplasma which do not grow on routine cultures. Common respiratory bacterial pathogens such as Pseudomonas are not included since they grow in cultures.