scholarly journals The Use of Antimicrobial Agents after Diagnosis of Viral Respiratory Tract Infections in Hospitalized Adults: Antibiotics or Anxiolytics?

2010 ◽  
Vol 31 (11) ◽  
pp. 1177-1183 ◽  
Author(s):  
Kevin T. Shiley ◽  
Ebbing Lautenbach ◽  
Ingi Lee
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Chest Radiograph ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Adult Patients ◽  
Abnormal Chest ◽  
Significant Difference ◽  
Tract Infections ◽  
Viral Respiratory

Objective.Because extensive antibiotic use by inpatients has been associated with the development of multidrug-resistant organisms, we aimed to determine which variables were associated with the use of antibiotics after viral respiratory tract infection diagnosis among adult patients admitted to the hospital with respiratory symptoms.Methods.A retrospective cohort study was conducted at 2 affiliated urban hospitals in Pennsylvania. We identified all adult patients admitted to the hospital during the period from November 1, 2005, through August 1, 2007, with a viral assay positive for influenza A or B, parainfluenza, adenovirus, or respiratory syncytial virus. Among these patients, we identified those who received antibiotics after the diagnosis of viral RTL Data on demographics; comorbidities; and physical examination, laboratory, and radiographic findings were ascertained to identify risk factors for antimicrobial use among these patients.Results.A total of 196 hospitalized patients with positive viral assay results were included; 125 of 131 patients administered antibiotics continued to receive them after viral RTI diagnosis. Among 52 patients with an abnormal chest radiograph, 46 continued antibiotic therapy. An abnormal chest radiograph was independently associated with continued antibiotic use (adjusted odds ratio, 4.28 [95% confidence interval, 1.71-10.77]; P = .002). However, the majority of patients (79 of 125 [63%]) who continued antibiotic therapy had normal chest imaging findings. Eight patients (6%) who continued antibiotic therapy and no patients who stopped developed C. difficile infection (95% CI, 1.5-00; p = .05), but there was no significant difference in length of stay or mortality.Conclusions.Antibiotics are commonly used to treat hospitalized patients with known acute viral RTIs. Continued use is strongly associated with abnormal radiograph findings at admission. However, the reasons for continuation of antibiotics in the treatment of the majority of patients with normal radiographs are unclear and may represent inappropriate use.

scholarly journals Viral Respiratory Tract Infections in Adult Patients Attending Outpatient and Emergency Departments, Taiwan, 2012–2013

Medicine ◽  
2015 ◽  
Vol 94 (38) ◽  
pp. e1545 ◽  
Author(s):  
Hsin-I Shih ◽  
Hsuan-Chen Wang ◽  
Ih-Jen Su ◽  
Hsiang-Chin Hsu ◽  
Jen-Ren Wang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Emergency Departments ◽  
Respiratory Tract Infections ◽  
Adult Patients ◽  
Tract Infections ◽  
Viral Respiratory

scholarly journals Use of Procalcitonin and a Respiratory Polymerase Chain Reaction Panel to Reduce Antibiotic Use via an Electronic Medical Record Alert

2019 ◽  
Vol 71 (7) ◽  
pp. 1684-1689 ◽  
Author(s):  
Tony Moradi ◽  
Nicholas Bennett ◽  
Shelby Shemanski ◽  
Kevin Kennedy ◽  
Andrew Schlachter ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Respiratory Tract ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Antibiotic Use ◽  
Chain Reaction ◽  
Days Of Therapy ◽  
Polymerase Chain ◽  
Tract Infections ◽  
Viral Respiratory

Abstract Background Respiratory tract infections are often viral and but are frequently treated with antibiotics, providing a significant opportunity for antibiotic de-escalation in patients. We sought to determine whether an automated electronic medical record best practice alert (BPA) based on procalcitonin and respiratory polymerase chain reaction (PCR) results could help reduce inappropriate antibiotic use in patients with likely viral respiratory illness. Methods This multisite, pre–post, quasi-experimental study included patients 18 years and older with a procalcitonin level <0.25 ng/mL and a virus identified on respiratory PCR within 48 hours of each other, and 1 or more systemic antibiotics ordered. In the study group, a BPA alerted providers of the diagnostic results suggesting viral infection and prompted them to reassess the need for antibiotics. The primary outcome measured was total antibiotic-days of therapy. Results The BPA reduced inpatient antibiotic-days of therapy by a mean of 2.2 days compared with patients who met criteria but did not have the alert fire (8.0 vs 5.8 days, respectively, P < .001). The BPA also reduced the percentage of patients prescribed antibiotics on discharge (20% vs 47.8%, P < .001), whereas there was no difference in need for antibiotic escalation after initial discontinuation (7.6% vs 4.3%, P = .198). Conclusions The automated antimicrobial stewardship BPA effectively reduced antibiotic use and discharge prescribing rates when diagnostics suggested viral respiratory tract infection, without a higher rate for reinitiation of antibiotics after discontinuation.

scholarly journals 240. Reduction of antibiotic use in children admitted with viral respiratory tract infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S120-S120
Author(s):  
Ankhi Dutta ◽  
Huay-Ying Lo ◽  
Amrita Singh ◽  
Samrah Mobeen ◽  
Kelli Kulik ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Significant Proportion ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Process Measures ◽  
Days Of Therapy ◽  
Tract Infections ◽  
Viral Respiratory

Abstract Background Viral respiratory tract infections (VRTI) accounts for a significant proportion of hospitalized children and contributes to a substantial use of health care resources and costs. American Academy of Pediatrics (AAP) recommends against using antibiotics in uncomplicated viral respiratory infections in children. Overuse of antibiotics ranges between 29–80%. The goal of an Antibiotic stewardship programs (ASP) is to decrease antibiotic misuse, lower costs, and prevent emergence of antibiotic resistance in the community. Proportion of children with Viral respiratory tract infections on antibiotics Methods Our smart aim was to reduce antibiotic use by 25% in admitted children with VRTI between October 2019-March 2020. Our outcome measure was to reduce inappropriate antibiotic use during the 2019–20 season by 25%. Process measures included percentage of antibiotic used in viral RTI, antibiotic days of therapy and appropriate audit-feedback from the ASP team to facilitate discontinuation or de-escalation of antibiotics based on culture data. Our balance measure included readmission rates in patients in whom antibiotics were discontinued or de-escalated. Several PDSA cycles implemented with predominant emphasis on communication between ASP team and primary providers. Results No differences were noted in patient demographics including sex, age, ethnicity between the viral season in 2018–19 and 2019–2020. In our previous study in 2018–2019 RSV season, there was 40.7% antibiotic use in patients admitted with RSV bronchiolitis. In 2019–2020 season we included all patients admitted with viral RTI. Of the 213 patients evaluated between October 2019 through Dec 2020, 40% of the patients received antibiotics. 100% of the antibiotics were justified, based on independent review of antibiotic data by the team. Most common cause of antibiotics were community acquired pneumonia, rule out sepsis and otitis media. Antibiotic discontinuation and de-escalation were achieved in over 90% of the justified antibiotics. Conclusion Though antibiotic usage was still at 40% at our institution, 100% of antibiotic use was deemed appropriate and significant proportion were discontinued or deescalated by the ASP team. The ASP team played a crucial role in communicating with the primary providers to advocate for appropriate antibiotic use in the children. Disclosures All Authors: No reported disclosures

Antimicrobial stewardship for hospitalized patients with viral respiratory tract infections

2017 ◽  
Vol 45 (8) ◽  
pp. 872-875 ◽  
Author(s):  
Christopher F. Lowe ◽  
Michael Payne ◽  
David Puddicombe ◽  
Allison Mah ◽  
Davie Wong ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antimicrobial Stewardship ◽  
Respiratory Tract Infections ◽  
Hospitalized Patients ◽  
Tract Infections ◽  
Viral Respiratory

scholarly journals Meta-Analysis and Systematic Review of Procalcitonin-Guided Therapy in Respiratory Tract Infections

2011 ◽  
Vol 55 (12) ◽  
pp. 5900-5906 ◽  
Author(s):  
Hui Li ◽  
Yi-Feng Luo ◽  
Timothy S. Blackwell ◽  
Can-Mao Xie
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Respiratory Tract Infections ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Tract Infections

ABSTRACTCirculating procalcitonin (PCT) is a biomarker that can be used in diagnosing bacterial infections. We performed a quantitative meta-analysis of available randomized controlled trials to determine whether antibiotic therapy based on PCT measurements alters clinical outcomes and antibiotic use in patients with lower respiratory tract infections. We identified studies through MEDLINE (1996 to 2010), the ISI Web of Knowledge (1996 to 2010), and Ovid. Studies that met our criteria were prospective, randomized controlled trials involving patients with respiratory tract infections. Outcomes of mortality, intensive care unit (ICU) admission, length of hospital stay, number of antibiotic prescriptions, and duration of antibiotic treatment were evaluated. Eight studies randomizing 3,431 patients met our criteria for inclusion. Pooled analysis showed a significant reduction in number of antibiotic prescriptions and duration of antibiotic use in patients with PCT-guided antibiotic treatment compared to standard therapy. In addition, the use of PCT-guided antibiotic therapy did not impact mortality, ICU admission, or length of hospital stay in these studies. A high degree of heterogeneity was identified in 3 of 5 outcomes that were evaluated, and sensitivity analysis indicated that heterogeneity was decreased among studies using the same PCT-based treatment algorithm. In conclusion, PCT-guided antibiotic therapy in patients with respiratory tract infections appears to reduce antibiotic use without affecting overall mortality or length of stay in the hospital.

Importance antibiotic therapy in treating children with recurrent upper respiratory tract infections

2015 ◽  
Vol 71 (7) ◽  
pp. 80-85
Author(s):  
A.O. Rudenko ◽  
◽  
O.O. Yukhimenko ◽  
N.A. Zelena ◽  
I.A. Tarasova ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections
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