Combining Procalcitonin and Rapid Multiplex Respiratory Virus Testing for Antibiotic Stewardship in Older Adult Patients With Severe Acute Respiratory Infection
Journal
Journal of the American Medical Directors Association
Journal Volume
21
Journal Issue
1
Pages
62
Date Issued
2020-01-01
Author(s)
Chang, Julia Chia Yu
Mao, Xiao Wei
Hsu, Wan Ting
How, Chorng Kuang
Abstract
© 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.
Subjects
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
SDGs
Other Subjects
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
Publisher
ELSEVIER SCIENCE INC
Type
journal article