Department of Pharmacy Services, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068, United States of America.
Advocate Aurora Research Institute, Advocate Aurora Health, 3075 Highland Parkway, Downers Grove, IL 60515, United States of America.
Am J Emerg Med. 2023 Sep;71:123-128. doi: 10.1016/j.ajem.2023.06.015. Epub 2023 Jun 15.
Influenza shares common symptoms with bacterial pneumonia, which may result in unnecessary antibiotic prescriptions in the emergency department (ED) when the diagnosis is unknown. Rapid influenza polymerase chain reaction (PCR) tests have reduced turnaround times compared to standard multiplex PCR respiratory panels allowing for earlier diagnosis, which may improve antimicrobial stewardship outcomes in the ED. This study aims to compare antibiotic and antiviral use before and after deployment of the rapid influenza PCR in the ED.
This single-center, retrospective, cohort study included pediatric and adult patients discharged from the ED with a positive influenza test using a standard multiplex PCR respiratory panel (January 2017 - July 2019) or rapid PCR (July 2019 - February 2020). The primary endpoint was number of antibiotic prescriptions pre- and post-implementation of the rapid influenza PCR in the ED. Secondary endpoints included number of antiviral prescriptions, duration of antimicrobial therapy, test turnaround time, ED length of stay, 30-day readmission, and adverse events. A multivariable logistic regression evaluated patient factors associated with antimicrobial prescribing.
A total of 620 positive influenza results were identified with 280 patients (standard multiplex PCR = 33; rapid PCR = 247) meeting inclusion criteria. Patients were less likely to be prescribed antibiotics (39.4% vs 8.9%, OR 0.15, 95% CI 0.067-0.34) and more likely to be prescribed antivirals (24.2% vs 61.1%, OR 4.92, 95% CI 2.13-11.34) with the rapid influenza PCR. Rapid influenza PCR significantly reduced ED length of stay (4.9 vs 3.4 h, p < 0.01) and test turnaround time (27 h vs 3.5 h, p < 0.01). Patients at high risk for complications associated with influenza were more likely to be prescribed antiviral therapy (22.7% vs 67.8%, OR 7.16, 95% CI 2.52-20.40). Based on the regression analysis conducted, asthma, (OR 3.5, 95% CI 1.48-8.26), immunosuppression (OR 9.6, 95% CI 1.18-78.2), and age <5 years old (OR 3.1, 95% CI 1.80-5.45) were predictors of antiviral prescribing.
Implementation of a rapid influenza PCR in the ED reduced antibiotic use and optimized antiviral therapy for patients with influenza including those at higher risk of complications.
流感与细菌性肺炎有共同的症状，这可能导致在急诊科（ED）诊断不明时开具不必要的抗生素处方。与标准多重 PCR 呼吸道检测板相比，快速流感聚合酶链反应（PCR）检测可缩短周转时间，从而更早地做出诊断，这可能会改善 ED 中的抗菌药物管理结果。本研究旨在比较快速流感 PCR 在 ED 中使用前后抗生素和抗病毒药物的使用情况。
这项单中心、回顾性、队列研究纳入了使用标准多重 PCR 呼吸道检测板（2017 年 1 月至 2019 年 7 月）或快速 PCR（2019 年 7 月至 2020 年 2 月）检测呈阳性的儿科和成年 ED 出院患者。主要终点是 ED 实施快速流感 PCR 前后抗生素处方的数量。次要终点包括抗病毒处方数量、抗菌药物治疗时间、检测周转时间、ED 住院时间、30 天再入院率和不良事件。多变量逻辑回归评估了与抗菌药物治疗相关的患者因素。
共确定了 620 例阳性流感结果，其中 280 例患者（标准多重 PCR=33 例；快速 PCR=247 例）符合纳入标准。使用快速流感 PCR 的患者抗生素处方的可能性更低（39.4% vs 8.9%，OR 0.15，95%CI 0.067-0.34），抗病毒药物处方的可能性更高（24.2% vs 61.1%，OR 4.92，95%CI 2.13-11.34）。快速流感 PCR 显著缩短了 ED 住院时间（4.9 小时 vs 3.4 小时，p<0.01）和检测周转时间（27 小时 vs 3.5 小时，p<0.01）。有流感相关并发症高风险的患者更有可能接受抗病毒治疗（22.7% vs 67.8%，OR 7.16，95%CI 2.52-20.40）。基于进行的回归分析，哮喘（OR 3.5，95%CI 1.48-8.26）、免疫抑制（OR 9.6，95%CI 1.18-78.2）和年龄<5 岁（OR 3.1，95%CI 1.80-5.45）是抗病毒药物处方的预测因素。
ED 中快速流感 PCR 的实施减少了抗生素的使用，并优化了流感患者的抗病毒治疗，包括那些有更高并发症风险的患者。
