scholarly journals Rapid Multiplex Testing for Upper Respiratory Pathogens in the Emergency Department: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Larissa May ◽  
Grant Tatro ◽  
Eduard Poltavskiy ◽  
Benjamin Mooso ◽  
Simson Hon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Usual Care ◽  
Controlled Trial ◽  
Antibiotic Use ◽  
Respiratory Pathogens ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections ◽  
The Impact

Abstract Background Acute upper respiratory tract infections are a common cause of Emergency Department (ED) visits and often result in unnecessary antibiotic treatment.  Methods We conducted a randomized clinical trial to evaluate the impact of a rapid, multi-pathogen respiratory panel (RP) test versus usual care (control). Patients were eligible if they were ≥12 months old, had symptoms of upper respiratory infection or influenza like illness, and were not on antibiotics. The primary outcome was antibiotic prescription; secondary outcomes included antiviral prescription, disposition, and length of stay (ClinicalTrials.gov# NCT02957136). Results Of 191 patients enrolled, 93 (49%) received RP testing; 98 (51%) received usual care. Fifty-three (57%) RP and 7 (7%) control patients had a virus detected and reported during the ED visit (p=0.0001). Twenty (22%) RP patients and 33 (34%) usual care patients received antibiotics during the ED visit (-12% [95% CI -25%, 0.4%]; p=0.06/0.08); 9 RP patients received antibiotics despite having a virus detected. The magnitude of antibiotic reduction was greater in children (-19%) versus adults (-9%; post-hoc analysis). There was no difference in antiviral use, length of stay, or disposition. Conclusions Rapid RP testing was associated with a trend towards decreased antibiotic use, suggesting a potential benefit from more rapid viral tests in the ED. Future studies should determine if specific groups are more likely to benefit from testing and evaluate relative cost and effectiveness of broad testing, focused testing, and a combined diagnostic and antimicrobial stewardship approach.

scholarly journals Evaluation of the Do Bugs Need Drugs? Program in British Columbia: Can We Curb Antibiotic Prescribing?

2011 ◽  
Vol 22 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Rachel M. McKay ◽  
Linda Vrbova ◽  
Elaine Fuertes ◽  
Mei Chong ◽  
Samara David ◽  
...  
Keyword(s):  
Program Implementation ◽  
Health Care Professionals ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Educational Material ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections ◽  
The Impact

OBJECTIVE: Antibiotic resistance is accelerated by the overuse of antibiotics. Do Bugs Need Drugs? is an educational program adapted in British Columbia to target both the public and health care professionals, with the aim of reducing unnecessary prescribing. The current article presents a descriptive evaluation of the impact of the program over the first four years.METHOD: Program implementation was measured by the amount of educational material distributed and the level of participation in educational sessions. The impact of the program was assessed by measuring changes in knowledge and prescribing habits of participating physicians, and by investigating provincial trends in antibiotic use.METHOD: Program implementation was measured by the amount of educational material distributed and the level of participation in educational sessions. The impact of the program was assessed by measuring changes in knowledge and prescribing habits of participating physicians, and by investigating provincial trends in antibiotic use.RESULTS: A total of 51,367 children, assisted-living residents and health care professionals have participated in the program since its inception in the fall of 2005. Pre- and postcourse assessments of participating physicians indicated significant improvements in clinical knowledge and appropriate antibiotic treatment of upper respiratory tract infections. Overall rates of antibiotic use in the province have stabilized since 2006. The rates of consumption of fluoroquinolones and macrolides have levelled off since 2005. Utilization rates for acute bronchitis are at the same level as when the program was first implemented, but rates for other acute upper respiratory tract infections of interest have declined.CONCLUSIONS: The Do Bugs Need Drugs? program significantly improves physician antibiotic prescription decisions and is ecologically associated with desirable change in population antibiotic consumption patterns.

scholarly journals Decrease of Antibiotic Consumption in Children with Upper Respiratory Tract Infections after Implementation of an Intervention Program in Cyprus

2011 ◽  
Vol 56 (3) ◽  
pp. 1658-1661 ◽  
Author(s):  
V. Papaevangelou ◽  
A. Rousounides ◽  
A. Hadjipanagis ◽  
A. Katsioulis ◽  
M. Theodoridou ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Intervention Program ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Upper Respiratory Tract ◽  
Attitudes And Practices ◽  
Consumption Reduction ◽  
Upper Respiratory ◽  
Tract Infections ◽  
The Impact

ABSTRACTTo assess the impact of intervention on antibiotic misuse in children, parents' and pediatricians' knowledge, attitudes, and practices (KAP) concerning antibiotic use were evaluated pre- and postintervention in Larnaca (Cyprus) and Limassol (Cyprus). Concurrently, pediatricians documented upper respiratory tract infection (URTI) visits and pharmacists provided antibiotic consumption data. Intervention was implemented for parents and pediatricians residing in Larnaca. The consumption/URTI incidence index was significantly reduced in Larnaca but not in Limassol. Parental responses to a KAP questionnaire remained unchanged; therefore, antibiotic consumption reduction is attributable to pediatricians' education.

scholarly journals A Novel Antimicrobial Stewardship Program-Guided Procalcitonin Initiative for Emergency Department Diagnosis of Bacterial Pneumonia in New York City

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S27-S28 ◽  
Author(s):  
George D Rodriguez ◽  
Roman Yashayev ◽  
Bella Yushuvayev ◽  
Anna Kula ◽  
Nathan Warren ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Antimicrobial Stewardship ◽  
Bacterial Pneumonia ◽  
Diagnostic Yield ◽  
Antibiotic Use ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Tract Infections ◽  
The Impact

Abstract Background An accurate diagnosis of bacterial pneumonia in the Emergency Department (ED) is challenging, resulting in inappropriate antibiotic use, adversely impacting patient care and safety. Procalcitonin (PCT), a serum biomarker, has good positive predictive value for bacterial lower respiratory tract infections. We sought to evaluate the impact of using PCT in an antimicrobial stewardship program (ASP)-driven algorithm to manage patients with presumed pneumonia in the ED. Methods We performed an IRB-approved quality initiative, 4-month retrospective evaluation of adult patients evaluated for pneumonia using PCT in a 515-bed university-affiliated hospital. Initial PCT use was restricted to ED for hemodynamically stable patients with presumed pneumonia. Subsequent PCT levels were ordered by ASP team members at 8- to 12-hours and days 3, 5, and 7 to guide the duration of antibiotic use and interpreted as per existing guidelines. Prior to start of initiative, aggressive education was provided by ASP to ED staff, followed by algorithm implementation. Outcomes included hospital admission, days of antibiotics, antibiotic use ≤48 hours, total PCT levels, length of stay, and 30-day pneumonia readmission. Results Baseline demographics of initial 182 patients differed between negative and positive PCT groups with age (78 vs. 84, P = 0.037) and sexfemale (88 vs. 15, P = 0.001). Negative PCT was associated with lower temperature (P = 0.0002), and white blood cell count (P = 0.0001) on admission (Figure 1). Patients with negative PCT had reduced antibiotic initiation (71% vs. 95%, P = 0.001) and were less likely to be admitted (89% vs. 98%, P = 0.078). A total of 460 PCT levels were collected [negative group: 303, median 2(2,2), positive group: 157, median 4(3,4)]. Patients with negative PCT had reduced antibiotic duration (P < 0.001) and length of stay (P = 0.004) (Figures 2 and 3). There were no reported adverse events or differences in 30-day pneumonia readmissions. Conclusion Implementation of a PCT algorithm through ASP is a novel and efficacious addition to improving diagnostic yield, targeting appropriate therapy, and reducing length of stay. The impact on antibiotic resistance remains to be determined. Disclosures All authors: No reported disclosures.

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