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Antimicrobial prescribing after rapid influenza PCR implementation in the emergency department
Alec Wesolowski1, Jessica L Miller1, Maureen Shields2
1Department of Pharmacy Services, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068, United States of America.
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.
Insights
Rapid influenza polymerase chain reaction (PCR) testing in the emergency department (ED) significantly reduced unnecessary antibiotic prescriptions and optimized antiviral use. This diagnostic improvement aids antimicrobial stewardship and patient care for influenza cases.
Area of Science:
- Infectious Diseases
- Clinical Diagnostics
- Antimicrobial Stewardship
Background:
- Influenza and bacterial pneumonia share symptoms, leading to potential overuse of antibiotics in emergency departments (EDs) when diagnoses are uncertain.
- Rapid influenza diagnostic tests offer faster results than traditional methods, potentially improving antimicrobial stewardship.
- This study evaluates the impact of rapid influenza PCR testing on antibiotic and antiviral prescribing patterns in the ED.
Purpose of the Study:
- To compare antibiotic and antiviral prescribing in the ED before and after the implementation of rapid influenza PCR testing.
- To assess the effect of rapid influenza PCR on key clinical and operational metrics within the ED.
Main Methods:
- A single-center, retrospective cohort study comparing pediatric and adult patients with positive influenza tests.
- Data collected on antibiotic/antiviral prescriptions, therapy duration, test turnaround time, ED length of stay, and readmissions.
- Multivariable logistic regression analyzed patient factors associated with antimicrobial prescribing.
Main Results:
- Rapid influenza PCR testing was associated with a significant decrease in antibiotic prescriptions (39.4% vs. 8.9%) and an increase in antiviral prescriptions (24.2% vs. 61.1%).
- The rapid test significantly reduced ED length of stay (4.9 vs. 3.4 hours) and test turnaround time (27 vs. 3.5 hours).
- Asthma, immunosuppression, and age under 5 were identified as predictors for antiviral prescribing.
Conclusions:
- Implementing rapid influenza PCR testing in the ED effectively reduces antibiotic utilization.
- The rapid test optimizes antiviral therapy, particularly for high-risk influenza patients.
- Faster diagnosis through rapid PCR improves antimicrobial stewardship and patient management in the ED.
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