Opportunities Revealed for Antimicrobial Stewardship and Clinical Practice with Implementation of a Rapid Respiratory Multiplex Assay
| Autor: | Cheston B. Cunha, Alison B. Chambers, Mariska Raglow-Defranco, Latha Sivaprasad, Cleo J Rochat, Diane M. Parente, Zoe Weiss, Leonard A. Mermel, Aimee Angus, Audrey V. Carr, Kimberle C. Chapin |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty 030106 microbiology respiratory pathogens antibiotic stewardship Microbial Sensitivity Tests Antimicrobial Stewardship 03 medical and health sciences 0302 clinical medicine Virology Internal medicine Multiplex polymerase chain reaction Humans Medicine Antimicrobial stewardship Public Health Surveillance Multiplex 030212 general & internal medicine Practice Patterns Physicians' Respiratory system Respiratory Tract Infections Adult patients business.industry Time to result Respiratory Pathogen Panel multiplex PCR Anti-Bacterial Agents Hospitalization Clinical Practice Female influenza business Multiplex Polymerase Chain Reaction |
| Zdroj: | Journal of Clinical Microbiology |
| ISSN: | 1098-660X 0095-1137 |
| DOI: | 10.1128/jcm.00861-19 |
| Popis: | Few studies assess the utility of rapid multiplex molecular respiratory panels in adult patients. Previous multiplex PCR assays took hours to days from order time to result. We analyze the clinical impact of switching to a molecular assay with a 3-h test-turnaround-time (TAT). Few studies assess the utility of rapid multiplex molecular respiratory panels in adult patients. Previous multiplex PCR assays took hours to days from order time to result. We analyze the clinical impact of switching to a molecular assay with a 3-h test-turnaround-time (TAT). We performed a retrospective review of adult patients who presented to our emergency departments with respiratory symptoms and had a respiratory viral panel (xTAG RVP; RVP) or respiratory pathogen panel (ePlex RP; RPP) within 48 h of presentation. The average TATs for the RVP and RPP were 27.9 and 3.0 h, respectively (P < 0.0001). In RVP-positive and RPP-positive patients, 68.9 and 44.5% of those with normal chest imaging received antibiotics (P = 0.013), while 95.4 and 89.6% of those with abnormal imaging received antibiotics, respectively (P = 0.187). There was no difference in antibiotic duration in RVP-positive and RPP-positive patients with abnormal chest imaging (6.2 and 6.0 days, respectively; P = 0.923) and normal chest imaging (4.5 and 4.3 days, respectively; P = 0.922). Fewer patients were admitted in the RPP-positive compared to the RVP-positive group (76.9 and 88.6%, respectively; P = 0.013), while the proportion of admissions were similar among RPP-negative and RVP-negative patients (85.3 and 87.1%, P = 0.726). Switching to a multiplex respiratory panel with a clinically actionable TAT is associated with reduced hospital admissions and, in admitted adults without focal radiographic findings, reduced antibiotic initiation. Opportunities to further mitigate inappropriate antibiotic use may be realized by combining rapid multiplex PCR with provider education, clinical decision-care algorithms, and active antibiotic stewardship. |
| Databáze: | OpenAIRE |
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