Combining Procalcitonin and Rapid Multiplex Respiratory Virus Testing for Antibiotic Stewardship in Older Adult Patients With Severe Acute Respiratory Infection

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J Am Med Dir Assoc. 2019 Nov 29. pii: S1525-8610(19)30701-7. doi: 10.1016/j.jamda.2019.09.020. [Epub ahead of print] Combining Procalcitonin and Rapid Multiplex Respiratory Virus Testing for Antibiotic Stewardship in Older Adult Patients With Severe Acute Respiratory Infection.

Lee CC¹, Chang JC², Mao XW³, Hsu WT⁴, Chen SY¹, Chen YC⁵, How CK⁶.
Author information

1 Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. 2 Department of Emergency Medicine, Taipei Veterans General Hospital and Department of Emergency Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 3 Department of Medical Technology, National Taiwan University Hospital, Taipei, Taiwan. 4 Department of Epidemiology, TH Chan Harvard School of Public Health, Boston, MA. 5 Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 6 Department of Emergency Medicine, Taipei Veterans General Hospital and Department of Emergency Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: ckhow@vghtpe.gov.tw.

Abstract

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.
Copyright ? 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.


KEYWORDS:

Older adults; antibiotic stewardship; coronavirus; human rhinovirus; influenza; point-of-care test; procalcitonin; rapid PCR respiratory panel; severe acute respiratory infections; viral panel

PMID: 31791902 DOI: 10.1016/j.jamda.2019.09.020