Implementation of a Stewardship Initiative on Respiratory Viral PCR‐based Antibiotic Deescalation
| Autor: | Gary W. Procop, Elizabeth A. Neuner, Andrea Pallotta, Kaitlyn Rivard, Samantha Loutzenheiser, Simon W. Lam, Pavithra Srinivas, Sandra S. Richter, Kristin Martinez, Vasilios Athans |
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| Rok vydání: | 2019 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Oseltamivir Time Factors medicine.drug_class 030106 microbiology Antibiotics 030204 cardiovascular system & hematology Antiviral Agents Polymerase Chain Reaction Antimicrobial Stewardship 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Levofloxacin Internal medicine medicine Humans Antimicrobial stewardship Pharmacology (medical) Aged Retrospective Studies business.industry Pneumonia Middle Aged medicine.disease Antimicrobial Anti-Bacterial Agents Withholding Treatment chemistry Viral pneumonia Ceftriaxone Respiratory virus Female business Program Evaluation medicine.drug |
| Zdroj: | Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 39:709-717 |
| ISSN: | 1875-9114 0277-0008 |
| Popis: | OBJECTIVE Respiratory viral polymerase chain reaction (RV PCR) tests assist in rapidly identifying viral pathogens and differentiating viral versus bacterial causes of pneumonia. Studies evaluating the use of RV PCR tests on antibiotic use in adults have demonstrated mixed results. We implemented an antimicrobial stewardship (ASP) intervention for patients with a positive RV PCR test result who were receiving broad-spectrum antibiotics and aimed to assess the impact on antibiotic usage. METHODS Retrospective quasi-experimental study of adult hospitalized patients comparing time to antibiotic deescalation, duration of antibiotic therapy, and antiviral use preintervention (January-March 2016) and postintervention (January-March 2017). RESULTS Of 172 ASP alerts reviewed, 55 (32%) were considered actionable. Of these, 47% of interventions were accepted. No significant difference was observed in median time to antibiotic deescalation (pre: 2.7 days vs post: 2.3 days, p=0.88). Time to discontinuation of antimicrobial therapy pre- and postintervention was reduced from 4 to 1.9 days (p=0.057) for piperacillin-tazobactam, from 2.7 to 1.8 days (p=0.75) for ceftriaxone, and from 3.6 to 2 days (p=0.4) for levofloxacin, respectively. Time to initiation of oseltamivir for influenza was significantly shorter in the postintervention group (pre: 11.3 hrs vs post: 3.6 hrs, p=0.02). CONCLUSION A third of patients receiving broad-spectrum antibiotics with a positive RV PCR had an opportunity for antimicrobial optimization, although this did not translate into a significant impact on the time to antibiotic deescalation or overall antibiotic use. Combination of RV PCR results with biomarkers to rule out bacterial coinfections and chest radiographic findings may help enhance the likelihood of accepted antibiotic deescalation recommendations and represents an area of future research. |
| Databáze: | OpenAIRE |
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