Premium
Implementation of a Stewardship Initiative on Respiratory Viral PCR‐based Antibiotic Deescalation
Author(s) -
Srinivas Pavithra,
Rivard Kaitlyn R.,
Pallotta Andrea M.,
Athans Vasilios,
Martinez Kristin,
Loutzenheiser Samantha,
Lam Simon W.,
Procop Gary W.,
Richter Sandra S.,
Neuner Elizabeth A.
Publication year - 2019
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2268
Subject(s) - medicine , antimicrobial stewardship , antibiotics , piperacillin , tazobactam , pneumonia , community acquired pneumonia , levofloxacin , intensive care medicine , antibiotic resistance , microbiology and biotechnology , imipenem , pseudomonas aeruginosa , biology , genetics , bacteria
Objective 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. Methods 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). Results 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). Conclusion 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.