Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-05T04:21:03.219Z Has data issue: false hasContentIssue false
  • English
  • Français

Role of rapid diagnostics for viral respiratory infections in antibiotic prescribing decision in the emergency department

Published online by Cambridge University Press:  28 June 2019

Jing Li Open the ORCID record for Jing Li [Opens in a new window] ,
S. Lena Kang-Birken ,
Samantha K. Mathews ,
Catelynn E. Kenner  and
Lynn N. Fitzgibbons
Jing Li
Affiliation:
Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, California
S. Lena Kang-Birken
Affiliation:
Department of Pharmacy Practice, Santa Barbara Cottage Hospital, Santa Barbara, California Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, California
Samantha K. Mathews
Affiliation:
Department of Medical Education, Santa Barbara Cottage Hospital, Santa Barbara, California
Catelynn E. Kenner
Affiliation:
Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, California
Lynn N. Fitzgibbons*
Affiliation:
Department of Medical Education, Santa Barbara Cottage Hospital, Santa Barbara, California
*
Author for correspondence: Lynn Fitzgibbons MD, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe the frequency of antibiotic prescriptions in patients with known viral respiratory infections (VRIs) diagnosed by polymerase chain reaction (PCR) in 3 emergency departments (EDs) and to identify patient characteristics that influence the prescribing of antibiotics by ED physicians despite PCR confirmation of viral cause.

Design:

Retrospective, observational analysis of patients with PCR-diagnosed VRI discharged from 3 acute-care hospital EDs within 1 health system.

Results:

In total, 323 patients were discharged from the ED with a VRI diagnosis, of whom 68 were prescribed antibiotics (21.1%). These patients were older (median, 59.5 vs 43 years; P = .04), experienced symptoms longer (median, 4 vs 2 days; P = .002), were more likely to have received antibiotics in the preceding 7 days (27.9% vs 9.8%; P < .001), and had higher proportions of abnormal chest X-rays (64.5% vs 28.4%; P < .001). Patients were more likely to receive antibiotics for a diagnosis of pneumonia (39.7% vs 1.6%; P < .001) or otitis media (7.4% vs 0.4%; P = .002), and were less likely with diagnosis of upper respiratory infection (2.9% vs 13.7%; P = .02) or influenza (20.6% vs 44.3%; P < .001).

Conclusions:

Despite a diagnosis of VRI, one-fifth of ED patients were prescribed antibiotics. Patient characteristics including age, duration of symptoms, abnormal chest X-rays, and specific diagnosis may increase provider concern for concurrent bacterial infections. Opportunities exist for antimicrobial stewardship strategies to incorporate rapid diagnostics in promoting judicious antibiotic usage in the ED.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 974 - 978
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 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: The preliminary results of this study were presented at IDWeek 2017 on October 7, 2017, in San Diego, California.

†

Present affiliation: Department of Infectious Disease, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

References

Falsey, AR, Murata, Y, Walsh, EE. Impact of rapid diagnosis on management of adults hospitalized with influenza. Arch Intern Med 2007;167:354–360.Google ScholarPubMed
Minino, AM, Arias, E, Kochanek, KD, Murphy, SL, Smith, BL. Deaths: final data for 2000. Natl Vital Stat Rep 2002;50:1–119.Google ScholarPubMed
Rui, P, Kang, K, Albert, M. National Hospital Ambulatory Medical Care Survey: 2013 Emergency Department Summary Tables. Centers for Disease Control and Protection website. https://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2013_ed_web_tables.pdf. Published 2013. Accessed June 3, 2019.Google Scholar
Harris, AM, Hicks, LA, Qaseem, A, High Value Care Task Force of the American College of P, for the Centers for Disease C, Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med 2016;164:425–434.Google ScholarPubMed
Centers for Disease C, Prevention. Office-related antibiotic prescribing for persons aged ≤14 years—United States, 1993–1994 to 2007–2008. Morb Mortal Wkly Rept 2011;60:1153–1156.Google Scholar
Centers for Disease C, Prevention. Vital signs: preventing Clostridium difficile infections. Morb Mortal Wkly Rept 2012;61:157–162.Google Scholar
Costelloe, C, Metcalfe, C, Lovering, A, Mant, D, Hay, AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010;340:c2096.CrossRefGoogle ScholarPubMed
Goossens, H, Ferech, M, Vander Stichele, R, Elseviers, M, Group, EP. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365:579–587.CrossRefGoogle ScholarPubMed
Pichichero, ME. Dynamics of antibiotic prescribing for children. JAMA 2002;287:3133–3135.CrossRefGoogle ScholarPubMed
Layman, CP, Gordon, SM, Elegino-Steffens, DU, Agee, W, Barnhill, J, Hsue, G. Rapid multiplex PCR assay to identify respiratory viral pathogens: moving forward diagnosing the common cold. Hawaii J Med Pub Health 2013;72(9 suppl 4):24–26.Google ScholarPubMed
Poritz, MA, Blaschke, AJ, Byington, CL, et al. FilmArray, an automated nested multiplex PCR system for multipathogen detection: development and application to respiratory tract infection. PLoS One 2011;6(10):e26047.CrossRefGoogle Scholar
Dawood, FS, Chaves, SS, Perez, A, et al. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003–2010. J Infect Dis 2014;209:686–694.CrossRefGoogle ScholarPubMed
Klein, EY, Monteforte, B, Gupta, A, et al . The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respir Virus 2016;10:394–403.CrossRefGoogle ScholarPubMed
Ghazi, IM, Nicolau, DP, Nailor, MD, Aslanzadeh, J, Ross, JW, Kuti, JL. Antibiotic utilization and opportunities for stewardship among hospitalized patients with influenza respiratory tract infection. Infect Control Hosp Epidemiol 2016;37:583–589.CrossRefGoogle ScholarPubMed
Oosterheert, JJ, van Loon, AM, Schuurman, R, et al . Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis 2005;41:1438–1444.CrossRefGoogle ScholarPubMed
Rogers, BB, Shankar, P, Jerris, RC, et al. Impact of a rapid respiratory panel test on patient outcomes. Arch Pathol Lab Med 2015;139:636–641.Google ScholarPubMed
Lowe, CF, Payne, M, Puddicombe, D, et al . Antimicrobial stewardship for hospitalized patients with viral respiratory tract infections. Am J Infect Control 2017;45:872–875.CrossRefGoogle ScholarPubMed
R: A Language and Environment for Statistical Computing [computer program]. R Foundation for Statistical Computing, Vienna, Austria; 2016.Google Scholar
Bursac, Z, Gauss, CH, Williams, DK, Hosmer, DW. Purposeful selection of variables in logistic regression. Source Code Biol Med 2008;3:17.CrossRefGoogle ScholarPubMed
Martinez, KA, Rood, M, Jhangiani, N, Kou, L, Boissy, A, Rothberg, MB. Association between antibiotic prescribing for respiratory tract infections and patient satisfaction in direct-to-consumer telemedicine. JAMA Intern Med 2018;178:1558–1560.CrossRefGoogle ScholarPubMed
May, L, Gudger, G, Armstrong, P, et al . Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. Infect Control Hosp Epidemiol 2014;35:1114–1125.CrossRefGoogle ScholarPubMed