https://scholars.lib.ntu.edu.tw/handle/123456789/510017
標題: | Combining Procalcitonin and Rapid Multiplex Respiratory Virus Testing for Antibiotic Stewardship in Older Adult Patients With Severe Acute Respiratory Infection | 作者: | CHIEN-CHANG LEE Chang, Julia Chia Yu Mao, Xiao Wei Hsu, Wan Ting SHEY-YING CHEN YEE-CHUN CHEN How, Chorng Kuang |
關鍵字: | antibiotic stewardship | coronavirus | human rhinovirus | influenza | Older adults | point-of-care test | procalcitonin | rapid PCR respiratory panel | severe acute respiratory infections | viral panel;antibiotic stewardship; coronavirus; human rhinovirus; influenza; Older adults; point-of-care test; procalcitonin; rapid PCR respiratory panel; severe acute respiratory infections; viral panel | 公開日期: | 1-一月-2020 | 出版社: | ELSEVIER SCIENCE INC | 卷: | 21 | 期: | 1 | 起(迄)頁: | 62 | 來源出版物: | Journal of the American Medical Directors Association | 摘要: | © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine Objectives: Virus infection is underevaluated in older adults with severe acute respiratory infections (SARIs). We aimed to evaluate the clinical impact of combining point-of-care molecular viral test and serum procalcitonin (PCT) level for antibiotic stewardship in the emergency department (ED). Design: A prospective twin-center cohort study was conducted between January 2017 and March 2018. Setting and Participants: Older adult patients who presented to the ED with SARIs received a rapid molecular test for 17 respiratory viruses and a PCT test. Measures: To evaluate the clinical impact, we compared the outcomes of SARI patients between the experimental cohort and a propensity score–matched historical cohort. The primary outcome was the proportion of antibiotics discontinuation or de-escalation in the ED. The secondary outcomes included duration of intravenous antibiotics, length of hospital stay, and mortality. Results: A total of 676 patients were included, of which 169 patients were in the experimental group and 507 patients were in the control group. More than one-fourth (27.9%) of the patients in the experimental group tested positive for virus. Compared with controls, the experimental group had a significantly higher proportion of antibiotics discontinuation or de-escalation in the ED (26.0% vs 16.1%, P = .007), neuraminidase inhibitor uses (8.9% vs 0.6%, P < .001), and shorter duration of intravenous antibiotics (10.0 vs 14.5 days, P < .001). Conclusions and Implications: Combining rapid viral surveillance and PCT test is a useful strategy for early detection of potential viral epidemics and antibiotic stewardship. Clustered viral respiratory infections in a nursing home is common. Patients transferred from nursing homes to ED may benefit from this approach. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/510017 | ISSN: | 15258610 | DOI: | 10.1016/j.jamda.2019.09.020 | SDG/關鍵字: | antibiotic agent; procalcitonin; sialidase inhibitor; antiinfective agent; antivirus agent; biological marker; procalcitonin; aged; antibiotic therapy; antimicrobial stewardship; antiviral therapy; Article; cohort analysis; controlled study; Coronavirinae; drug withdrawal; emergency care; Enterovirus; female; human; Human parainfluenza virus 3; Human rhinovirus; Influenza A virus; Influenza B virus; length of stay; major clinical study; male; Metapneumovirus; multicenter study; multiplex polymerase chain reaction; nonhuman; observational study; outcome assessment; prescription; propensity score; prospective study; protein blood level; respiratory virus; treatment duration; viral respiratory tract infection; virus detection; antimicrobial stewardship; blood; case control study; complication; middle aged; procedures; respiratory tract infection; virus infection; Aged; Anti-Bacterial Agents; Antimicrobial Stewardship; Antiviral Agents; Biomarkers; Case-Control Studies; Female; Humans; Male; Middle Aged; Procalcitonin; Prospective Studies; Respiratory Tract Infections; Virus Diseases |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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