148 Rate of Antibiotics Prescribed for Patients With Acute Diarrheal Illness and a Positive Stool Test in Immunosuppressed Versus Non-Immunosuppressed Patients

Abstract

INTRODUCTION: Historically, the diagnostic yield of stool culture in patients with acute diarrheal illness (ADI) is very low. As such, the decision to administer antibiotics is usually guided by history of exposures, symptoms, and the degree of immune-competence. The advent of a gastrointestinal (GI) pathogen PCR panel offers a sensitive and rapid identification of various GI pathogens but its heuristic relevance in antibiotic stewardship for immunosuppressed patients is unknown. We aimed to compare the rate of antibiotics prescribed for ADI with positive GI pathogen PCR panel results in immunosuppressed and non-immunosuppressed patients. METHODS: Patients who presented to Montefiore Medical Center with an ADI with a positive GI pathogen PCR panel between April 2018 and November 2018 were identified. Data collected included patient demographics, toxic habits, and previous antibiotic and steroid use within 6 months prior to the ADI. Immunosuppressed patients were identified as having either HIV/AIDS, a history of organ transplant, active hematologic malignancy, primary immunodeficiency disease or current use of immunosuppressive medications. We excluded patients with C. difficile given its confounding effect on the rate of antibiotic administration. The primary outcome was whether antibiotics were prescribed for the ADI empirically as well as in response to a positive GI pathogen PCR panel result. RESULTS: Out of 472 patients, 102 patients (21.6% of the cohort) were identified as being immunosuppressed (Table 1). There was no significant difference in the rate of empiric antibiotic use between immunosuppressed and non-immunosuppressed patients with ADI (12.2% vs 10.8%, P = 0.181) (Table 2). There was also no significant difference in the rate of antibiotic use in response to a positive GI pathogen PCR panel result (49% vs 38.9%, P = 0.182). CONCLUSION: The ability to tailor treatment to a specific pathogen in patients with ADI does not appear to make a significant difference in the rate of antibiotic use when accounting for patients' immune-competence. As certain pathogens warranting treatment tend to be more common in immunosuppressed patients, the implications on clinical outcomes and cost effectiveness of the GI pathogen PCR panel requires further study.