Implementation of a Stewardship Initiative on Respiratory Viral PCR-based Antibiotic Deescalation

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Clinical Microbiology

Background:

• Respiratory viral polymerase chain reaction (RV PCR) tests rapidly identify viral pathogens, aiding in differentiating viral from bacterial pneumonia.
• Previous studies on RV PCR test impact on adult antibiotic use show mixed results.
• Antimicrobial stewardship programs (ASP) aim to optimize antibiotic prescribing.

Purpose of the Study:

• To assess the impact of an antimicrobial stewardship intervention on antibiotic usage in hospitalized patients with positive RV PCR results.
• To evaluate changes in time to antibiotic deescalation and overall antibiotic duration post-intervention.

Main Methods:

• Retrospective quasi-experimental study comparing adult patients pre- and post-intervention (2016 vs. 2017).
• Intervention focused on patients with positive RV PCR results receiving broad-spectrum antibiotics.
• Key metrics included time to antibiotic deescalation, duration of therapy, and antiviral use.

Main Results:

• Of 172 ASP alerts, 55 (32%) were actionable, with 47% accepted.
• No significant difference in median time to antibiotic deescalation (2.7 vs. 2.3 days, p=0.88).
• Time to oseltamivir initiation for influenza significantly decreased post-intervention (11.3 hrs vs. 3.6 hrs, p=0.02).

Conclusions:

• A third of patients with positive RV PCR had optimization opportunities, but the intervention did not significantly impact antibiotic deescalation or overall use.
• Combining RV PCR with biomarkers and radiographic findings may improve antibiotic deescalation success.
• Further research is needed to enhance the effectiveness of RV PCR in guiding antibiotic therapy.