2237. Early Discontinuation of Antibacterials Is Safe for Patients with Community-Acquired Pneumonia (CAP) Who Have a Positive Viral Test, Negative Tests for Bacteria, and Low Procalcitonin

Abstract

BackgroundStudies using molecular testing methods have found monomicrobial infection with a virus as the etiology of CAP in adult patients admitted to the hospital in 6–30% of cases. The use of antibacterial agents in such patients is unnecessary, and can lead to untoward consequences. A test confirming a viral etiology may reduce the needless use of antibiotics, especially if the procalcitonin (PCT) level is low, suggesting that bacterial co-infection is unlikely. Our Antimicrobial Stewardship Program (ASP) routinely follows patients admitted with respiratory tract infections, and provides recommendations for appropriate therapy based on diagnostic test results as well as PCT levels. We present a retrospective evaluation of our experience.MethodsA retrospective review of ASP interventions on patients admitted to Summa Health System—Akron Campus was performed for the time frame of January 2018–March 2019. Patients were included if they had a positive viral PCR result (VERIGENE™, BioFire™), a PCT level <0.25 ng/mL (BioMérieux™, Abbott™), negative bacterial studies, and an accepted intervention to discontinue antimicrobial therapy made by the ASP.ResultsThe ASP assessed 131 patients with positive viral PCR studies and low PCT levels who had antimicrobials discontinued based on ASP recommendations; 68 with CAP and 63 without pneumonia (WPNA) as demonstrated on imaging. Most patients in the WPNA category had acute exacerbation of COPD. Common viruses identified were Influenza A or B, Rhinovirus and RSV. Mean duration of antibiotics was 2.6 days for CAP and 2.4 days for WPNA (Table 1). The 30-day readmission rate was similar for each group, and for CAP patients was similar for all-cause pneumonia patients at our institution (14% during similar time period). 30-day Mortality of CAP patients was low.ConclusionWhile national guidelines recommend a minimum of 5 days of antimicrobial therapy for CAP patients, we have observed that discontinuing antibiotics well before that is safe if a viral etiology is identified without evidence of bacterial co-infection (including low PCT) and results in less antibiotic usage. Reduction in unnecessary antibiotic use has the potential to improve the quality of care for adults with CAP. Disclosures All authors: No reported disclosures.