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Role of rapid diagnostics for viral respiratory infections in antibiotic prescribing decision in the emergency department

Published online by Cambridge University Press:  28 June 2019

Jing Li Open the ORCID record for Jing Li [Opens in a new window] ,
S. Lena Kang-Birken ,
Samantha K. Mathews ,
Catelynn E. Kenner  and
Lynn N. Fitzgibbons
Jing Li
Affiliation:
Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, California
S. Lena Kang-Birken
Affiliation:
Department of Pharmacy Practice, Santa Barbara Cottage Hospital, Santa Barbara, California Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, California
Samantha K. Mathews
Affiliation:
Department of Medical Education, Santa Barbara Cottage Hospital, Santa Barbara, California
Catelynn E. Kenner
Affiliation:
Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, California
Lynn N. Fitzgibbons*
Affiliation:
Department of Medical Education, Santa Barbara Cottage Hospital, Santa Barbara, California
*
Author for correspondence: Lynn Fitzgibbons MD, E-mail: lfitzgibbons@sbch.org
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Abstract

Objective:

To describe the frequency of antibiotic prescriptions in patients with known viral respiratory infections (VRIs) diagnosed by polymerase chain reaction (PCR) in 3 emergency departments (EDs) and to identify patient characteristics that influence the prescribing of antibiotics by ED physicians despite PCR confirmation of viral cause.

Design:

Retrospective, observational analysis of patients with PCR-diagnosed VRI discharged from 3 acute-care hospital EDs within 1 health system.

Results:

In total, 323 patients were discharged from the ED with a VRI diagnosis, of whom 68 were prescribed antibiotics (21.1%). These patients were older (median, 59.5 vs 43 years; P = .04), experienced symptoms longer (median, 4 vs 2 days; P = .002), were more likely to have received antibiotics in the preceding 7 days (27.9% vs 9.8%; P < .001), and had higher proportions of abnormal chest X-rays (64.5% vs 28.4%; P < .001). Patients were more likely to receive antibiotics for a diagnosis of pneumonia (39.7% vs 1.6%; P < .001) or otitis media (7.4% vs 0.4%; P = .002), and were less likely with diagnosis of upper respiratory infection (2.9% vs 13.7%; P = .02) or influenza (20.6% vs 44.3%; P < .001).

Conclusions:

Despite a diagnosis of VRI, one-fifth of ED patients were prescribed antibiotics. Patient characteristics including age, duration of symptoms, abnormal chest X-rays, and specific diagnosis may increase provider concern for concurrent bacterial infections. Opportunities exist for antimicrobial stewardship strategies to incorporate rapid diagnostics in promoting judicious antibiotic usage in the ED.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 974 - 978
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: The preliminary results of this study were presented at IDWeek 2017 on October 7, 2017, in San Diego, California.

†

Present affiliation: Department of Infectious Disease, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

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