Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.
Department of Pharmacy, Cleveland Clinic Avon Hospital, Avon, Ohio.
Pharmacotherapy. 2019 Jun;39(6):709-717. doi: 10.1002/phar.2268. Epub 2019 May 20.
Respiratory viral polymerase chain reaction (RV PCR) tests assist in rapidly identifying viral pathogens and differentiating viral versus bacterial causes of pneumonia. Studies evaluating the use of RV PCR tests on antibiotic use in adults have demonstrated mixed results. We implemented an antimicrobial stewardship (ASP) intervention for patients with a positive RV PCR test result who were receiving broad-spectrum antibiotics and aimed to assess the impact on antibiotic usage.
Retrospective quasi-experimental study of adult hospitalized patients comparing time to antibiotic deescalation, duration of antibiotic therapy, and antiviral use preintervention (January-March 2016) and postintervention (January-March 2017).
Of 172 ASP alerts reviewed, 55 (32%) were considered actionable. Of these, 47% of interventions were accepted. No significant difference was observed in median time to antibiotic deescalation (pre: 2.7 days vs post: 2.3 days, p=0.88). Time to discontinuation of antimicrobial therapy pre- and postintervention was reduced from 4 to 1.9 days (p=0.057) for piperacillin-tazobactam, from 2.7 to 1.8 days (p=0.75) for ceftriaxone, and from 3.6 to 2 days (p=0.4) for levofloxacin, respectively. Time to initiation of oseltamivir for influenza was significantly shorter in the postintervention group (pre: 11.3 hrs vs post: 3.6 hrs, p=0.02).
A third of patients receiving broad-spectrum antibiotics with a positive RV PCR had an opportunity for antimicrobial optimization, although this did not translate into a significant impact on the time to antibiotic deescalation or overall antibiotic use. Combination of RV PCR results with biomarkers to rule out bacterial coinfections and chest radiographic findings may help enhance the likelihood of accepted antibiotic deescalation recommendations and represents an area of future research.
呼吸道病毒聚合酶链反应（RV PCR）检测有助于快速识别病毒病原体，并区分病毒性肺炎与细菌性肺炎。评估 RV PCR 检测在成人抗生素使用中的应用的研究结果不一。我们针对 RV PCR 检测结果阳性且正在接受广谱抗生素治疗的患者实施了一项抗菌药物管理（ASP）干预，并旨在评估其对抗生素使用的影响。
回顾性准实验研究，比较了干预前（2016 年 1 月至 3 月）和干预后（2017 年 1 月至 3 月）接受 RV PCR 检测结果阳性且正在接受广谱抗生素治疗的成年住院患者的抗生素降级时间、抗生素治疗持续时间和抗病毒药物使用情况。
在审查的 172 项 ASP 警报中，55 项（32%）被认为具有可操作性。其中，47%的干预措施被接受。抗生素降级时间的中位数无显著差异（干预前：2.7 天 vs 干预后：2.3 天，p=0.88）。干预前后，哌拉西林他唑巴坦的抗菌药物治疗停药时间从 4 天缩短至 1.9 天（p=0.057），头孢曲松从 2.7 天缩短至 1.8 天（p=0.75），左氧氟沙星从 3.6 天缩短至 2 天（p=0.4）。流感患者使用奥司他韦的起始时间在干预后组显著缩短（干预前：11.3 小时 vs 干预后：3.6 小时，p=0.02）。
尽管三分之一的 RV PCR 检测结果阳性且正在接受广谱抗生素治疗的患者有机会进行抗菌药物优化，但这并未显著影响抗生素降级时间或总体抗生素使用。将 RV PCR 检测结果与生物标志物相结合以排除细菌合并感染和胸部 X 线检查结果，可能有助于提高接受抗生素降级建议的可能性，这是未来研究的一个领域。
