Antimicrobial prescribing after rapid influenza PCR implementation in the emergency department.

Autor: Wesolowski A; Department of Pharmacy Services, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068, United States of America. Electronic address: alec.wesolowski@aah.org., Miller JL; Department of Pharmacy Services, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068, United States of America. Electronic address: jessica.miller@aah.org., Shields M; Advocate Aurora Research Institute, Advocate Aurora Health, 3075 Highland Parkway, Downers Grove, IL 60515, United States of America. Electronic address: maureen.shields@aah.org., Dela-Pena J; Department of Pharmacy Services, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068, United States of America. Electronic address: cliftoj@ccf.org.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2023 Sep; Vol. 71, pp. 123-128. Date of Electronic Publication: 2023 Jun 15.
DOI: 10.1016/j.ajem.2023.06.015
Abstrakt: Intro: Influenza shares common symptoms with bacterial pneumonia, which may result in unnecessary antibiotic prescriptions in the emergency department (ED) when the diagnosis is unknown. Rapid influenza polymerase chain reaction (PCR) tests have reduced turnaround times compared to standard multiplex PCR respiratory panels allowing for earlier diagnosis, which may improve antimicrobial stewardship outcomes in the ED. This study aims to compare antibiotic and antiviral use before and after deployment of the rapid influenza PCR in the ED.
Methods: This single-center, retrospective, cohort study included pediatric and adult patients discharged from the ED with a positive influenza test using a standard multiplex PCR respiratory panel (January 2017 - July 2019) or rapid PCR (July 2019 - February 2020). The primary endpoint was number of antibiotic prescriptions pre- and post-implementation of the rapid influenza PCR in the ED. Secondary endpoints included number of antiviral prescriptions, duration of antimicrobial therapy, test turnaround time, ED length of stay, 30-day readmission, and adverse events. A multivariable logistic regression evaluated patient factors associated with antimicrobial prescribing.
Results: A total of 620 positive influenza results were identified with 280 patients (standard multiplex PCR = 33; rapid PCR = 247) meeting inclusion criteria. Patients were less likely to be prescribed antibiotics (39.4% vs 8.9%, OR 0.15, 95% CI 0.067-0.34) and more likely to be prescribed antivirals (24.2% vs 61.1%, OR 4.92, 95% CI 2.13-11.34) with the rapid influenza PCR. Rapid influenza PCR significantly reduced ED length of stay (4.9 vs 3.4 h, p < 0.01) and test turnaround time (27 h vs 3.5 h, p < 0.01). Patients at high risk for complications associated with influenza were more likely to be prescribed antiviral therapy (22.7% vs 67.8%, OR 7.16, 95% CI 2.52-20.40). Based on the regression analysis conducted, asthma, (OR 3.5, 95% CI 1.48-8.26), immunosuppression (OR 9.6, 95% CI 1.18-78.2), and age <5 years old (OR 3.1, 95% CI 1.80-5.45) were predictors of antiviral prescribing.
Conclusion: Implementation of a rapid influenza PCR in the ED reduced antibiotic use and optimized antiviral therapy for patients with influenza including those at higher risk of complications.
Competing Interests: Declaration of Competing Interest The authors have no potential conflicts of interest to disclose.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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