95. Assess reasons for continuing antibiotics in persons with positive respiratory viruses PCR in the emergency room

Abstract

BackgroundRespiratory tract infections remain one of the major reasons for inappropriate antibiotic usage. The multiplex PCR respiratory viral panel improves the diagnostic ability of viral causes of RTI and have been advocated as a useful stewardship tool. We sought to evaluate factors leading to continued antibiotic following a positive respiratory viral PCR and to evaluate the impact of a targeted antimicrobial stewardship intervention on antibiotic use.MethodsIn this Quasi experimental study, adult patients presenting to RVH ER with positive respiratory PCR from January 13 2020 to February 27 2020 were reviewed. Patient demographics, clinical, comorbidities, laboratory and radiology reports, antibiotic and antiviral usage before and after test were recorded. For patients without microbiological or radiological evidence of bacterial infection, a standard questionnaire was administered to treating physician. Antibiotic prescribing rate before and following a positive PCR and antibiotic discontinuation following ASP questionnaire was tracked.ResultsDuring the study period, 147 adult patients presented to the ER with positive respiratory PCR were. Among the study population, antibiotic prescription rate was 49% prior to test result. Influenza was the most common respiratory virus isolated(89/147). Following the respiratory viral PCR, antibiotics were stopped 39% and continued in 51 % by the treating physician. Main reasons for antibiotic continuation included concurrent bacterial infection16/30 (pneumonia 9/30), COPD exacerbation 5/30, febrile neutropenia (5/30) and hemodynamic instability(4/30). Antibiotics were continued without obvious indications in 15 patients and were targeted for intervention. Overall 66% (10/15) of ASP interventions were accepted and antibiotics discontinued. Overall antibiotics were discontinued in 53 % of patients in whom they were initiated pretest result.ConclusionThis study shows that positive respiratory virus PCR is very useful as it led to discontinuation of antibiotics by treating physician in 40 % and further 13% by an antibiotic stewardship intervention. Adding a stewardship intervention after test result further adds reduction to antibiotic usage.Disclosures All Authors: No reported disclosures