Antimicrobial stewardship for hospitalized patients with viral respiratory tract infections

Lowe, Christopher F.; Payne, Michael; Puddicombe, David; Mah, Allison; Wong, Davie; Kirkwood, Allison; Hull, Mark; Leung, Victor

doi:10.1016/j.ajic.2017.03.025

Cited by 33 publications

(35 citation statements)

References 17 publications

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“…In some acute hospital settings, reporting similar results directly to attending physicians has also not been sufficient to change antibiotic prescribing behaviors. [24][25][26] In hospitals, reporting the PCR result to an AMS team along with specific advice from the AMS team about antibiotic cessation is required to impact prescribing behavior. 24 Slow transfer of information, lack of confidence in the results, and other factors within the nursing homes, such as work flow, resident mix, and prescriber preferences for overly cautious antibiotic prescribing, 27 may have affected the outcome of this study.…”

Section: Discussionmentioning

confidence: 99%

“…However, the current study suggests additional resources may be required to influence antibiotic prescribing behaviors for RTIs in nursing homes. Guidance from clinical algorithms or other support, such as input from an AMS clinician, 24 in addition to nurse-initiated PCR testing, may be required to impact antibiotic prescribing for RTIs in nursing homes.…”

Section: Discussionmentioning

confidence: 99%

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Optimizing treatment of respiratory tract infections in nursing homes: Nurse-initiated polymerase chain reaction testing

Dowson

Marshall

Buising

et al. 2019

American Journal of Infection Control

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Background: Diagnostic testing using polymerase chain reaction (PCR) is infrequently initiated for diagnosis of respiratory tract infections (RTIs) in nursing homes. The objectives of this study were to determine the feasibility of implementing nurse-initiated PCR testing of respiratory specimens in nursing home settings and to compare antibiotic prescribing prior to and during the implementation. Methods: This was a pragmatic, historically controlled study in 3 nursing homes (181 total beds) in Melbourne, Australia. Results: The number of PCR tests of respiratory specimens (over 12 months) increased from 5 to 67 when nurses could initiate the tests. Residents with RTI symptoms had a virus identified by PCR in 50.7% of tests, including 14 positive for influenza. Six outbreaks were identified. When clustering was taken into consideration, incidence rates of antibiotic days of therapy did not change (incidence rate ratio = 0.94, 95% confidence interval, 0.25-3.35, P = .92) despite identification of more viral pathogens. Conclusions: In nursing homes, nurse-initiated PCR testing of respiratory specimens is feasible and useful in terms of identifying the cause of many RTIs and outbreaks, and viruses are common in this context. However, the current study suggests the availability of these test results alone does not impact antibiotic prescribing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Optimizing treatment of respiratory tract infections in nursing homes: Nurse-initiated polymerase chain reaction testing

Dowson

Marshall

Buising

et al. 2019

American Journal of Infection Control

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“…There was no difference in days on antibiotics or in adverse events between the standard care group and the intervention group, which had an additional viral testing and PCT measurement provided with graded recommendations for antibiotic use based on PCT levels [16]. In a Canadian quasi-experimental before-and-after study combining virology testing with an antimicrobial stewardship intervention, a 1.3-day decrease in mean days on antibiotics was noted compared with the previous year [17]. Without counselling, physicians seem to respond less to positive viral results other than influenza and rely more on radiographic findings when deciding on antibiotic treatment, as shown in a prospective observational study conducted in a Canadian tertiary hospital [18].…”

Section: Discussionmentioning

confidence: 97%

Impact of multiplex respiratory virus testing on antimicrobial consumption in adults in acute care: a randomized clinical trial

Saarela

Tapiainen

Kauppila

et al. 2020

Clinical Microbiology and Infection

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a b s t r a c tObjectives: Inappropriate use of antibiotics is associated with development of antimicrobial resistance. In respiratory infections it is often difficult to differentiate between viral and bacterial infections, and empirical treatment is common. Enhanced viral testing is expected to clarify clinical decision-making and reduce the prescription of antibacterial agents, but the impact of such information on patient care is unclear. Methods: We conducted a (1:1) randomized controlled clinical trial involving 998 adults with respiratory symptoms, fever, chest pain or poor general condition in the emergency unit of a tertiary hospital. Multiplex PCR results for 496 patients were available in 24 hours (intervention group) and those for the remaining 502 patients were available in 7 days (control group). Our primary outcome measures were the duration of hospitalization and the consumption of antibiotics within 30 days of enrolment. Results: In all, 841 of 998 (84%) patients had respiratory symptoms at study entry. A respiratory virus was detected in 175 (17.5%). The mean duration of hospitalization was 4.2 days (SD 5.4) in the intervention group and 4.1 days (SD 4.9) in the control group (difference 0.1, 95% CI e0.5 to 0.6, p 0.810). The mean days on antibiotics were 11.3 days (SD 12.6) in the intervention group and 10.4 days (SD 11.4) in the control group (difference 0.9, 95% CI e0.6 to 2.4, p 0.235). Conclusions: Multiplex PCR testing for respiratory viruses with results available within 24 hours did not reduce the consumption of bacterial antibiotics or the length of hospital stay in adults presenting with respiratory symptoms, fever, chest pain or reduced general condition in acute care. E. Saarela, Clin Microbiol Infect 2019;▪:1

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“…Timely diagnosis of influenza virus infection is important to manage patients, control infection, and prevent the inappropriate use of antibiotics (Low, 2008;Lowe et al, 2017). Molecular methods, such as isothermal nucleic acid amplification, offer significant advantages such as relatively short TATs and simple setups.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, clinicians rely on in vitro diagnostic methods to confirm influenza virus infection. Therefore, early and accurate diagnosis is not only important for managing the infection but also for minimizing the unnecessary prescription of antibiotics (Low, 2008;Lowe et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Development and evaluation of a rapid nucleic acid amplification method to detect influenza A and B viruses in human respiratory specimens

Elf

Auvinen

Jahn

et al. 2018

Diagnostic Microbiology and Infectious Disease

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Isothermal nucleic acid amplification methods can potentially shorten the amount of time required to diagnose influenza. We developed and evaluated a novel isothermal nucleic acid amplification method, RT-SIBA to rapidly detect and differentiate between influenza A and B viruses in a single reaction tube. The performance of the RT-SIBA Influenza assay was compared with two established RT-PCR methods. The sensitivities of the RT-SIBA, RealStar RT-PCR, and CDC RT-PCR assays for the detection of influenza A and B viruses in the clinical specimens were 98.8%, 100%, and 89.3%, respectively. All three assays demonstrated a specificity of 100%. The average time to positive result was significantly shorter with the RT-SIBA Influenza assay (<20 min) than with the two RT-PCR assays (>90 min). The method can be run using battery-operated, portable devices with a small footprint and therefore has potential applications in both laboratory and near-patient settings.

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Antimicrobial stewardship for hospitalized patients with viral respiratory tract infections

Cited by 33 publications

References 17 publications

Optimizing treatment of respiratory tract infections in nursing homes: Nurse-initiated polymerase chain reaction testing

Optimizing treatment of respiratory tract infections in nursing homes: Nurse-initiated polymerase chain reaction testing

Impact of multiplex respiratory virus testing on antimicrobial consumption in adults in acute care: a randomized clinical trial

Development and evaluation of a rapid nucleic acid amplification method to detect influenza A and B viruses in human respiratory specimens

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