Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-05T21:23:26.615Z Has data issue: false hasContentIssue false
  • English
  • Français

Antibiotic Utilization and Opportunities for Stewardship Among Hospitalized Patients With Influenza Respiratory Tract Infection

Published online by Cambridge University Press:  01 February 2016

Islam M. Ghazi ,
David P. Nicolau ,
Michael D. Nailor ,
Jaber Aslanzadeh ,
Jack W. Ross  and
Joseph L. Kuti
Islam M. Ghazi
Affiliation:
Center for Anti-infective Research and Development, Hartford Hospital, Hartford, Connecticut
David P. Nicolau
Affiliation:
Center for Anti-infective Research and Development, Hartford Hospital, Hartford, Connecticut Division of Infectious Diseases, Hartford Hospital, Hartford, Connecticut
Michael D. Nailor
Affiliation:
University of Connecticut, School of Pharmacy, Storrs, Connecticut Department of Pharmacy, Hartford Hospital, Hartford, Connecticut
Jaber Aslanzadeh
Affiliation:
Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, Connecticut
Jack W. Ross
Affiliation:
Division of Infectious Diseases, Hartford Hospital, Hartford, Connecticut
Joseph L. Kuti*
Affiliation:
Center for Anti-infective Research and Development, Hartford Hospital, Hartford, Connecticut
*
Address correspondence to Joseph L. Kuti, PharmD, Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour St., Hartford, CT 06102 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

Hospitalized influenza patients are often treated with antibiotics empirically while awaiting final diagnosis. The goal of this study was to describe the inappropriate continuation of antibiotics for influenza respiratory tract infections (RTIs).

DESIGN

We retrospectively studied adults admitted to our institution over 2 respiratory flu seasons with positive influenza RTIs. Inappropriate antibiotic duration (IAD) was defined as antibiotic use for >24 hours after a positive influenza test in patients presenting with <72 hours of RTI symptoms and with no other indications of bacterial infection.

RESULTS

During the study period, 322 patients included in this study were admitted for influenza RTI. Respiratory cultures were ordered for 50 of these patients (15.5%) and 71 patients (22%) had a positive chest x-ray, but antibiotics were prescribed to 211 patients (65.5%) on admission. Antibiotics were inappropriately continued in 73 patients (34.5%). Patients receiving IAD had a longer length of stay (LOS) (median, 6 days; range, 4–9 days) compared with those whose antibiotics were discontinued appropriately (median, 5 days; range, 3–8 days) and those who were not treated with antibiotics (median, 4 days; range, 3–6 days; P<.001). However, mortality was similar among these 3 groups: 3 patients (4.1%) from the IAD cohort died; 6 patients (4.3%) from the group with an appropriate antibiotic duration died; and 2 patients [1.8%] from the group given no antibiotics died (P=.510). The 30-day readmission rates were similar as well: 9 patients (12.3%) from the IAD group were readmitted within 30 days; 21 patients (15.2%) from the group with appropriate antibiotic duration were readmitted; and 11 patients (9.9%) from the group given no antibiotics were readmitted (P=.455). Total hospital costs were greater in patients treated with IAD ($10,645; range, $6,485–$18,035) compared with the group treated with appropriate antibiotic duration ($7,479; range, $4,866–$12,922) and the group given no antibiotics $5,961 (range, $4,711–$9,575). Thus, the hospital experienced a median loss in net hospital revenue of $2,076 per IAD patient compared with a patient for which antibiotic duration was appropriate.

CONCLUSION

The majority of patients with influenza RTI received antibiotics on admission, and 34.5% were inappropriately continued on antibiotics without evidence of bacterial infection, which led to increased LOS, loss of net revenue, and no improvement in outcome. Thus, stewardship initiatives aimed at this population are warranted.

Infect Control Hosp Epidemiol 2016;37:583–589

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 5 , May 2016 , pp. 583 - 589
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. An abstract of this data set was presented at the Joint 55th Interscience Conference on Antimicrobial Agents and Chemotherapy and 28th International Congress of Chemotherapy Meeting (ICAAC/ICC) 2015, San Diego, California, September 18, 2015.

References

REFERENCES

1. Mizgerd, JP. Acute lower respiratory tract infection. N Eng J Med 2008;358:716–727.CrossRefGoogle ScholarPubMed
2. Deaths, Final Data for 2013. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf. Accessed December 23, 2015.Google Scholar
3. De Roux, A, Marcos, MA, Garcia, E, et al. Viral community-acquired pneumonia in immunocompromised adults. Chest 2004;125:1343–1351.Google Scholar
4. Angeles Marcos, M, Camps, M, Pumarola, T, et al. The role of viruses in community-acquired pneumonia in adults. Antivir Ther 2006;11:351–359.Google Scholar
5. Saito, A, Kohno, S, Matsushima, T, et al. Prospective multicenter study of causative organisms of community-acquired pneumonia in adults in Japan. J Infect Chemother 2006;12:36–39.Google Scholar
6. Jennings, LC, Anderson, TP, Beynon, KA, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 2008;63:42–48.CrossRefGoogle ScholarPubMed
7. Bello, S, Minchole, E, Fandos, S, et al. Inflammatory response in mixed viral-bacterial community-acquired pneumonia. BMC Pulmonol Med 2014;14:123.Google Scholar
8. Harper, SA, Bradley, JS, Englund, JS, et al. Seasonal influenza in adults and children- diagnosis, treatment, chemoprophylaxis and institutional outbreak management: Practice guidelines of the infectious diseases society of America. Clin Infect Dis 2009;48:1003–1032.CrossRefGoogle ScholarPubMed
9. Nicholson, KG, Wood, JM, Zambon, M. Influenza. Lancet 2003;362:1733–1745.Google Scholar
10. Thompson, WW, Shay, DK, Weintraub, E, et al. Influenza-associated hospitalizations in the United States. JAMA 2004;292:1333–1340.Google Scholar
11. Belshe, RB. The origins of pandemic influenza—lessons from the 1918 virus. N Engl J Med 2005;353:2209–2211.Google Scholar
12. Linder, JA, Nieva, HR, Blummentals, WA. Antiviral and antibiotic prescribing for influenza in primary care. J Gen Intern Med 2009;24:504–510.Google Scholar
13. Oxford, JS. Influenza a pandemics of the 20th century with special reference to 1918: virology, pathology and epidemiology. Rev Med Virol 2000;10:119–133.Google Scholar
14. Lipatov, AS, Govorkova, EA, Webby, RJ, et al. Influenza: Emergence and control. J Virol 2004;78:8951–8959.CrossRefGoogle ScholarPubMed
15. Grijalva, CG, Nuorti, JP, Griffin, MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 2009;302:758–766.Google Scholar
16. Roumie, CL, Halasa, NB, Grijalva, CG, et al. Trends in antibiotic prescribing for adults in the United States—1995–2002. J Gen Intern Med 2005;20:697–702.CrossRefGoogle Scholar
17. Xu, T, Roberts, D, Sulapas, I, Martinez, O, Berk, J, Baldwin, J. Over-prescribing of antibiotics and imaging in the management of uncomplicated URIs in emergency departments. BMC Emerg Med 2013;13:7.Google Scholar
18. Loo, VG, Bourgault, AM, Poirier, L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Eng J Med 2011;365:1693–1703.Google Scholar
19. Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society of Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.Google Scholar
20. Yam, P, Fales, D, Jemison, J, Gillum, M, Bernstein, M. Implementation of an antimicrobial stewardship in a rural hospital. Am J Health-Syst Pharm 2012;69:1142–1148.Google Scholar
21. Bartlett, J, Siola, PL. Implementation and first-year results of an antimicrobial stewardship program at a community hospital. Am J Health-Syst Pharm 2014;71:943–949.CrossRefGoogle Scholar
22. Joseph, C, Togawa, Y, Shindo, N. Bacterial and viral infections associated with influenza. Influenza Other Respir Viruses 2013;7(Suppl 2):105–113.Google Scholar
23. Report to the President on Combating Antimicrobial Resistance. President’s Council of Advisors on Science and Technology website. https://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_carb_report_sept2014.pdf. Published 2014. Accessed December 23, 2015.Google Scholar
24. Jeong, HW, Heo, JY, Park, JS, Kim, WJ. Effect of the influenza virus rapid antigen test on a physician’s decision to prescribe antibiotics and on patient length of stay in the emergency department. PLoS One 2014;9:e110978.Google Scholar
25. Linder, JA, Bates, DW, Platt, R. Antivirals and antibiotics for influenza in the United States, 1995–2002. Pharmacoepidemiol Drug Saf 2005;14:531–536.CrossRefGoogle ScholarPubMed
26. Mandell, LA, Wunderink, RG, Anzueto, A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community acquired pneumonia in adults. Clin Infect Dis 2007;44(Suppl 2):S27–S72.Google Scholar
27. Miyashita, N, Shimizu, H, Ouchi, K, et al. Assessment of the usefulness of sputum Gram stain and culture for diagnosis of community-acquired pneumonia requiring hospitalization. Med Sci Monit 2008;14:CR171–CR176.Google ScholarPubMed
28. Jain, S, Self, WH, Wunderink, RG, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med 2015;373:415–427.CrossRefGoogle Scholar
29. Schuetz, P, Christ-Crain, M, Thomann, R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections. The ProHOSP randomized controlled trial. JAMA 2009;302:1059–1066.Google Scholar
30. Pfister, R, Kochanek, M, Leygeber, T, et al.. Procalcitonin for diagnosis of bacterial pneumonia in critically ill patients during 2009 H1N1 influenza pandemic: a prospective cohort study, systematic review and individual patient data meta-analysis. Crit Care 2014;18:R44.Google Scholar
31. Walsh, EE, Swinburne, AJ, Becker, KL, Nylen, ES, Snider, RH, Baran, A, et al. Can serum procalcitonin levels help interpret indeterminate chest radiographs in patients hospitalized with acute respiratory illness? J Hosp Med 2013;8:61e7.Google Scholar
32. Lindstrom, ST, Wong, EK. Procalcitonin, a valuable biomarker assisting clinical decision-making in the management of community-acquired pneumonia. Intern Med J 2014;44:390–397.Google Scholar