Abstract
BackgroundDespite well-defined criteria for use of antibiotics in patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), their overuse is widespread. We hypothesized that following implementation of a molecular multiplex respiratory viral panel (RVP), AECOPD patients with viral infections would be more easily identified, limiting antibiotic use in this population. The primary objective of our study was to investigate if availability of the RVP decreased antibiotic prescription at discharge among patients with AECOPD.MethodsThis is a single center, retrospective, before (pre-RVP) - after (post-RVP) study of patients admitted to a tertiary medical center from January 2013 to March 2016. The primary outcome was antibiotic prescription at discharge. Groups were compared using univariable and multivariable logistic-regression.ResultsA total of 232 patient-episodes were identified, 133 following RVP introduction. Mean age was 68.1 (pre-RVP) and 68.3 (post-RVP) years respectively (p = 0.88). Patients in pre-RVP group were similar to the post-RVP group with respect to gender (p = 0.54), proportion of patients with BMI < 21(p = 0.23), positive smoking status (p = 0.19) and diagnoses of obstructive sleep apnea (OSA, p = 0.16). We found a significant reduction in antibiotic prescription rate at discharge in patients admitted with AECOPD after introduction of the respiratory viral assay (pre-RVP 77.8% vs. post-RVP 63.2%, p = 0.01). In adjusted analyses, patients in the pre-RVP group [OR 2.11 (CI: 1.13–3.96), p = 0.019] with positive gram stain in sputum [OR 4.02 (CI: 1.61–10.06), p = 0.003] had the highest odds of antibiotic prescription at discharge.ConclusionsIn patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), utilization of a comprehensive respiratory viral panel can significantly decrease the rate of antibiotic prescription at discharge.
Highlights
Despite well-defined criteria for use of antibiotics in patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), their overuse is widespread
We conducted a retrospective analysis of data from our center and assessed the pattern of antibiotic prescription at discharge before and after the introduction of a molecular multiplex viral assay in patients admitted to medical floors with acute exacerbations of chronic obstructive pulmonary disease (COPD). This was a single center, retrospective, before - after study to assess the difference in antibiotic prescription at discharge following availability of a PCR based, rapid, multiplex diagnostic viral assay as an intervention in adult patients admitted to the hospital floor with acute exacerbation of COPD
We found a significant reduction in antibiotic prescription rate at discharge in patients admitted with AECOPD after introduction of the respiratory viral assay in the patient cohort at our center
Summary
Despite well-defined criteria for use of antibiotics in patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), their overuse is widespread. We hypothesized that following implementation of a molecular multiplex respiratory viral panel (RVP), AECOPD patients with viral infections would be more identified, limiting antibiotic use in this population. Acute exacerbations of COPD (AECOPD) are a frequent precipitant for hospitalization, and about 70% of cases can be attributed to respiratory infections [4]. While for many healthy individuals, respiratory viral illnesses (RVIs) are acute and self-limiting, patients with COPD are vulnerable to prolonged and complicated clinical courses [7]. There is an increasing pressure on our hospital systems to diagnose, treat and discharge patients quickly, which has led to overuse of antibiotics even for viral etiologies of various infections. Given the dwindling pipeline of new antimicrobials as well as the rising burden of antimicrobial resistance, judicious use of antibiotics by limiting their use to patients who have a bacterial infection is of paramount importance [10]
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