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138. Impact of Emergency Department Rapid Viral Respiratory Multiplex PCR Testing on Antimicrobial Prescribing

BACKGROUND: Rapid multiplex polymerase chain reaction (mPCR) point-of-care tests detect a variety of viral respiratory pathogens. The impact of mPCR results on antibiotic prescribing in the ED or downstream is not well understood. The purpose of this study was to assess the impact of positive viral...

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Autores principales: Falk, Cassandra, Dumkow, Lisa E, Geyer, Abigail, Egwuatu, Nnaemeka, Langholz, Jennifer, Schmidt, Kyle, Jameson, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677803/
http://dx.doi.org/10.1093/ofid/ofad500.211
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author Falk, Cassandra
Dumkow, Lisa E
Geyer, Abigail
Egwuatu, Nnaemeka
Langholz, Jennifer
Schmidt, Kyle
Jameson, Andrew
author_facet Falk, Cassandra
Dumkow, Lisa E
Geyer, Abigail
Egwuatu, Nnaemeka
Langholz, Jennifer
Schmidt, Kyle
Jameson, Andrew
author_sort Falk, Cassandra
collection PubMed
description BACKGROUND: Rapid multiplex polymerase chain reaction (mPCR) point-of-care tests detect a variety of viral respiratory pathogens. The impact of mPCR results on antibiotic prescribing in the ED or downstream is not well understood. The purpose of this study was to assess the impact of positive viral mPCR results on antibiotic prescribing for patients presenting with respiratory symptomsin the ED. METHODS: This retrospective cohort study included adult patients presenting to the ED with respiratory symptoms and a positive rapid upper RTI mPCR for a non-SARs-CoV-2 viral pathogen between 11/1/2021 and 10/31/2022. The primary objective was to describe the proportion of patients with appropriate antibiotic management within 24 hours of positive mPCR result. Appropriate management was defined as patients without risk factors for bacterial co-infection who did not receive or continue antibiotic therapy. Those with co-infection risk factors prescribed antibiotic therapy were also considered appropriate. This was determined through independent pharmacist and ID physician review. Secondary objectives compared patient outcomes of those appropriately vs inappropriately managed and admitted vs discharged home from ED. Risk factors for inappropriate antibiotic decisions were also evaluated using logistic regression. RESULTS: 250 patients were included, 206 (82.4%) with appropriate management and 44 (17.6%) with inappropriate management. 164 (65.5%) patients were not prescribed empiric or definitive antibiotics. 39 (15.6%) patients empirically received antibiotics prior to mPCR; 9 (23%) were discontinued following positive viral result. Patients discharged home from the ED were more likely to have appropriate antibiotic management than those admitted (87.5% vs 77.7%, p=0.042). Patients with inappropriate antibiotic management were more likely to be readmitted to the hospital within 30 days (14% vs 3.5%, p=0.005). Purulent sputum (OR 3.61 [95% CI 1.64-8]) and unilobar infiltrate (OR 3.03 [1.22-7.58]) were independent risk factors for inappropriate antibiotic management. CONCLUSION: Rapid viral RTI mPCR testing in the ED resulted in a high level of appropriate antibiotic management, with most patients not being prescribed antibiotics. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-106778032023-11-27 138. Impact of Emergency Department Rapid Viral Respiratory Multiplex PCR Testing on Antimicrobial Prescribing Falk, Cassandra Dumkow, Lisa E Geyer, Abigail Egwuatu, Nnaemeka Langholz, Jennifer Schmidt, Kyle Jameson, Andrew Open Forum Infect Dis Abstract BACKGROUND: Rapid multiplex polymerase chain reaction (mPCR) point-of-care tests detect a variety of viral respiratory pathogens. The impact of mPCR results on antibiotic prescribing in the ED or downstream is not well understood. The purpose of this study was to assess the impact of positive viral mPCR results on antibiotic prescribing for patients presenting with respiratory symptomsin the ED. METHODS: This retrospective cohort study included adult patients presenting to the ED with respiratory symptoms and a positive rapid upper RTI mPCR for a non-SARs-CoV-2 viral pathogen between 11/1/2021 and 10/31/2022. The primary objective was to describe the proportion of patients with appropriate antibiotic management within 24 hours of positive mPCR result. Appropriate management was defined as patients without risk factors for bacterial co-infection who did not receive or continue antibiotic therapy. Those with co-infection risk factors prescribed antibiotic therapy were also considered appropriate. This was determined through independent pharmacist and ID physician review. Secondary objectives compared patient outcomes of those appropriately vs inappropriately managed and admitted vs discharged home from ED. Risk factors for inappropriate antibiotic decisions were also evaluated using logistic regression. RESULTS: 250 patients were included, 206 (82.4%) with appropriate management and 44 (17.6%) with inappropriate management. 164 (65.5%) patients were not prescribed empiric or definitive antibiotics. 39 (15.6%) patients empirically received antibiotics prior to mPCR; 9 (23%) were discontinued following positive viral result. Patients discharged home from the ED were more likely to have appropriate antibiotic management than those admitted (87.5% vs 77.7%, p=0.042). Patients with inappropriate antibiotic management were more likely to be readmitted to the hospital within 30 days (14% vs 3.5%, p=0.005). Purulent sputum (OR 3.61 [95% CI 1.64-8]) and unilobar infiltrate (OR 3.03 [1.22-7.58]) were independent risk factors for inappropriate antibiotic management. CONCLUSION: Rapid viral RTI mPCR testing in the ED resulted in a high level of appropriate antibiotic management, with most patients not being prescribed antibiotics. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2023-11-27 /pmc/articles/PMC10677803/ http://dx.doi.org/10.1093/ofid/ofad500.211 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Falk, Cassandra
Dumkow, Lisa E
Geyer, Abigail
Egwuatu, Nnaemeka
Langholz, Jennifer
Schmidt, Kyle
Jameson, Andrew
138. Impact of Emergency Department Rapid Viral Respiratory Multiplex PCR Testing on Antimicrobial Prescribing
title 138. Impact of Emergency Department Rapid Viral Respiratory Multiplex PCR Testing on Antimicrobial Prescribing
title_full 138. Impact of Emergency Department Rapid Viral Respiratory Multiplex PCR Testing on Antimicrobial Prescribing
title_fullStr 138. Impact of Emergency Department Rapid Viral Respiratory Multiplex PCR Testing on Antimicrobial Prescribing
title_full_unstemmed 138. Impact of Emergency Department Rapid Viral Respiratory Multiplex PCR Testing on Antimicrobial Prescribing
title_short 138. Impact of Emergency Department Rapid Viral Respiratory Multiplex PCR Testing on Antimicrobial Prescribing
title_sort 138. impact of emergency department rapid viral respiratory multiplex pcr testing on antimicrobial prescribing
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677803/
http://dx.doi.org/10.1093/ofid/ofad500.211
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