Acute Respiratory Infections In Adults Research Articles

Clinical-epidemiological characterization and etiological agents of severe acute respiratory infections in adults in Paraguay

Clinical-epidemiological characterization and etiological agents of severe acute respiratory infections in adults in Paraguay

Environmental Determinants and Hygiene Habits Related to the Development of Acute Respiratory Infections in Adults Attending P/s OPC, León III Quarter, 2023

Environmental Determinants and Hygiene Habits Related to the Development of Acute Respiratory Infections in Adults Attending P/s OPC, León III Quarter, 2023

Long-term symptom profiles after COVID-19 vs other acute respiratory infections: an analysis of data from the COVIDENCE UK study

Long COVID is a well recognised, if heterogeneous, entity. Acute respiratory infections (ARIs) due to other pathogens may cause long-term symptoms, but few studies compare post-acute sequelae between SARS-CoV-2 and other ARIs. We aimed to compare symptom profiles between people with previous SARS-CoV-2 infection, people with previous non-COVID-19 ARIs, and contemporaneous controls, and to identify clusters of long-term symptoms. COVIDENCE UK is a prospective, population-based UK study of ARIs in adults. We analysed data for 16potential long COVID symptoms and health-related quality of life (HRQoL), reported between January 21 and February 15, 2021, by participants unvaccinated against SARS-CoV-2. We classified participants as having previous SARS-CoV-2 infection or previous non-COVID-19 ARI (≥4 weeks prior) or no reported ARI. We compared symptoms by infection status using logistic and fractional regression, and identified symptom clusters using latent class analysis (LCA). This study is registered with ClinicalTrials.gov, NCT04330599. We included 10,171 participants (1311 [12.9%] with SARS-CoV-2 infection, 472 [4.6%] with non-COVID-19 ARI). Both types of infection were associated with increased prevalence/severity of most symptoms and decreased HRQoL compared with no infection. Participants with SARS-CoV-2 infection had increased odds of problems with taste/smell (odds ratio 19.74, 95% CI 10.53-37.00) and lightheadedness or dizziness (1.74, 1.18-2.56) compared with participants with non-COVID-19 ARIs. Separate LCA models identified three symptom severity groups for each infection type. In the most severe groups (representing 22% of participants for both SARS-CoV-2 and non-COVID-19 ARI), SARS-CoV-2 infection presented with a higher probability of problems with taste/smell (probability 0.41 vs 0.04), hair loss (0.25 vs 0.16), unusual sweating (0.38 vs 0.25), unusual racing of the heart (0.43 vs 0.33), and memory problems (0.70 vs 0.55) than non-COVID-19 ARI. Both SARS-CoV-2 and non-COVID-19 ARIs are associated with a wide range of symptoms more than 4 weeks after the acute infection. Research on post-acute sequelae of ARIs should extend from SARS-CoV-2 to include other pathogens. Barts Charity.

Household Air Pollution: A Dire Need Of Awareness In Pakistan.

Dear Editor, Household Air Pollution [HAP] has proven to be associated with an increased risk of acquiring asthma, lung cancer, pulmonary tuberculosis, and acute respiratory infections in adults and children, along with Chronic Obstructive Pulmonary Disease [COPD], cerebrovascular disease, ischemic heart disease, low birth weight, and stillbirth [1]. This pollution is caused primarily by the absence of clean fuels, which includes electricity, biogas, natural gas, liquefied petroleum gas (LPG), solar, or alcohol fuels. Owing to the absence of clean fuels, individuals resort to the use of biomass to meet their needs, exposing themselves to the detrimental effects of biomass usage. Unfortunately, Pakistan is one of the worst-faring victims of this predicament. As of 2020, only 49.3% of Pakistanis primarily relied on clean fuels and technologies for cooking [2]. With only 26% of rural areas having access to clean fuels, traditional, inefficient three-stone stoves for biomass combustion are typical in rural areas[2][3]. Such stoves expel poisonous gasses, including Nitrogen oxides, Carbon monoxide, and formaldehyde, in addition to several toxic organic compounds depending on the type of biomass used, all detrimental to human health [4]. In urban areas, especially in winter, widespread gas shortages are prevalent, restricting an unknown number of citizens to biomass combustion for their day-to-day purposes. In both scenarios, the harms of HAP are imminent. Unfortunately, using gas stoves in poorly ventilated areas also shows milder effects of HAP [5]. Alarmingly, despite the adverse impact and the high prevalence of HAP, the matter remains neglected, with only very few studies connecting the above-stated health risks with the Pakistani population, evaluating the burden Pakistan bears because of HAP, and assessing the correct strategies for intervention. Such studies would result in implementing specific research-backed mitigation strategies customized to be specifically applicable to different socioeconomic backgrounds and regions of Pakistan, for example, efficient ventilatory systems relevant to Pakistani houses designed to reduce HAP. In the meantime, examples of general policies include, but are not limited to, television advertisements, awareness drives, and allotting larger budgets towards cleaner fuel provision. For people utilizing primitive three-stone stoves, a plancha stove, comprising simply a stove and a chimney, can also be provided. The usage of such stoves is associated with a significantly reduced exposure to HAP [6]. Individually, when operating stoves for any purpose, it is crucial to prioritize ventilation. ---Continue

Prevention of covid-19 and other acute respiratory infections with cod liver oil supplementation, a low dose vitamin D supplement: quadruple blinded, randomised placebo controlled trial

ObjectiveTo determine if daily supplementation with cod liver oil, a low dose vitamin D supplement, in winter, prevents SARS-CoV-2 infection, serious covid-19, or other acute respiratory infections in adults in...

Гострі респіраторні інфекції у дорослих у практиці лікаря першої ланки

Гострі респіраторні інфекції (ГРІ) є найбільш поширеними інфекційними захворюваннями, що вражають усі вікові групи населення, але насамперед — дітей до 5 років, дорослих старше 65 років або людей з факторами ризику і серйозними хронічними процесами, що підвищують ризик розвитку ускладнень і важких форм захворювання. За даними ВОЗ (інформаційний бюлетень № 310, травень 2014 р.), у 2012 році респіраторні інфекції нижніх дихальних шляхів були однією з 10 причин смерті у світі. У США смертність від грипу і його ускладнень становить в середньому 20 тис. осіб щорічно, а прямі витрати на лікування хворих на грип — 1–3 млрд дол., непрямі — 10–15 млрд дол. на рік. В Україні щороку на ГРІ хворіє 10–14 млн осіб, що становить 25–30 % загальної захворюваності і приблизно 75–90 % інфекцій в країні. На захворювання, викликані вірусами грипу, припадає не більше 8 %. У періоди епідемічного підйому (в зимовий період, пік в основному спостерігається в лютому) ця цифра зростає до 25 %. Протягом епідемічного сезону 2014–2015 рр. на ГРІ перехворіли 3 млн 700 тис. осіб, що становило 9,1 % всього населення країни. Економічні збитки від грипу досягають близько 400 млн грн. на рік. Збитки тільки від одного випадку захворювання грипом в країні оцінюють у суму, еквівалентну 100 дол. США (включаючи витрати, пов’язані з тимчасовою непрацездатністю, витрати на лікування ускладнень і організацію протиепідемічних заходів). У питаннях гострого риносинуситу (ГРІ та інших) індивідуальний і епідемічний підходи лікаря повинні поєднуватися в межах медичної науки і професійного мистецтва. Після проведення диференціальної діагностики лікар вирішує питання, пов’язані з направленням пацієнта в стаціонар, на консультацію до лор-лікаря, на амбулаторне обстеження (лабораторне або інструментальне) і т.д. На підставі такої об’ємної і необхідної інформаційної та рекомендаційної бази сьогодні незалежність і професійна свобода лікаря все ж залишаються вирішальними.

C-reactive protein testing to reduce antibiotic prescribing for acute respiratory infections in adults: a systematic review and meta-analysis.

BackgroundAntimicrobial resistance (AMR) has become a worldwide public health problem. Abuse of antibiotic in acute respiratory tract infections (ARI) contributes to the increasing AMR. C-reactive protein (CRP) testing may help reduce antibiotic overprescribing, but the available evidence quality varies widely. There is no meta-analysis of CRP testing to guide the antibiotic prescribing for adult ARI. Therefore, we conducted this meta-analysis to determine the effectiveness of CRP testing to guide antibiotic prescribing in adult ARI.MethodsWe searched the Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials (RCTs) involving our meta-analysis from the establishment of these databases until January 16, 2021. Two reviewers extracted the data separately and pooled the data using RevMan5.3. The evidence quality was appraised strictly with GRADE system.ResultsSeven studies included with 3,614 patients. Compared with routine care, CRP testing reduced antibiotic prescribing rate at the index consultation significantly [risk ratio (RR) =0.76; 95% confidence interval (CI): 0.68–0.85; P<0.00001], and during 28 days follow-up (RR =0.77; 95% CI: 0.73–0.81; P<0.00001). There were no significant differences between CRP testing and routine care in clinical recovery of patients within 7 days (RR =0.95; 95% CI: 0.90–1.01; P=0.08). Moreover, adverse events were not significantly different between CRP testing and routine care.DiscussionCRP testing can reduce the antibiotic prescribing rate at index consultation and during 28 days follow-up. These findings support the conclusion that CRP testing is valuable to guide the antibiotic prescribing for adult ARI.

Disease Burden Estimates of Respiratory Syncytial Virus related Acute Respiratory Infections in Adults With Comorbidity: A Systematic Review and Meta-Analysis.

Respiratory syncytial virus related acute respiratory infection (RSV-ARI) constitutes a substantial disease burden in adults with comorbidities. We aimed to identify all studies investigating the disease burden of RSV-ARI in this group. We estimated the incidence, hospitalization rate, and in-hospital case fatality ratio (hCFR) of RSV-ARI in adults with comorbidities based on a systematic review of studies published between January 1996 and March 2020. We also investigated the association between RSV-ARI and any comorbidity in adults. Meta-analyses based on random effects model were carried out. Overall, 20 studies were included. The annual incidence rate of RSV-ARI in adults with any comorbidity was 37.6 (95% confidence interval [CI], 20.1-70.3) per 1000 persons per year in industrialized countries and the seasonal incidence rate was 28.4 (11.4-70.9) per 1000 persons per season. The hCFR in industrialized countries was 11.7% (5.8%-23.4%). There were no studies in developing countries. There were insufficient data to generate the meta-estimate of hospitalization rate. The likelihood of experiencing RSV-ARI for those with any comorbidity compared to those without was estimated to be 4.1 (odds ratio [OR], 1.6-10.4) and 1.1 (OR, 0.6-1.8) from studies using univariable and multivariable analysis respectively. The disease burden of RSV-ARI among adults with comorbidity is substantial with limited data available.

Antibiotic utilization for adult acute respiratory tract infections in United States Emergency Departments.

Antibiotic stewardship programs have been a major focus in recent years to curtail antibiotic resistance. The purpose of this study was to evaluate antibiotic utilization for acute respiratory tract infections (ARTI) in the Emergency Department (ED) setting. A retrospective analysis of adult ARTI visits to EDs utilizing 2011-2017 National Hospital Ambulatory Medical Care Survey- Emergency Department (NHAMCS-ED) datasets was conducted. Included were all visits of adults (≥18 years) diagnosed with ARTI. Antibiotics were determined based upon NHAMCS-ED use of the Multum Lexicon Drug Database coding system. All significance tests were two-sided, P-value <0.05 for significance. A total of 4632 unweighted ED visits, which represented more than 28 million US ED visits from 2011 to 2017, with 57.2% receiving a prescription for antibiotics. Antibiotic prescriptions for ARTI significantly declined from 65.8% in 2011 to 54.3% in 2017 (P = 0.046). Among all visits, patients were more likely to receive an antibiotic if they were over age 45 (33.0% vs 27.6%, P = 0.005), male (36.7% vs. 32.3%, P = 0.039), and presenting in a non-MSA ED (21.4% vs. 14.5%, P = 0.002). No association was found between antibiotic prescription and race (P = 0.076) insurance (P = 0.488), CBC (P = 0.148), x-ray (P = 0.278), and blood cultures (P = 0.182). We found a significant reduction in the utilization of antibiotics among adult ARTI visits to U.S. EDs from 2011 to 2017. This is an improvement from previous studies which showed no change, suggesting that antimicrobial stewardship efforts may be impacting overall antibiotic use and should continue to be practiced.

Viral etiology of severe acute respiratory infections in adults in Kuala Lumpur, Malaysia

Background: Severe acute respiratory infections (SARI) pose a great global burden. The contribution of respiratory viruses in adults is relatively understudied in Asia. Emerging respiratory viruses, such as MERS-CoV and SARS-CoV have been reported in Asia, including in Malaysia. Methods and materials: From May 2017, adult patients with community-acquired SARI admitted to an urban teaching hospital in Kuala Lumpur were prospectively enrolled to comprehensively determine viral etiology. Respiratory samples were tested for 20 common respiratory pathogens (using the Luminex NxTAG-RPP assay) and MERS-CoV and SARS-CoV by RT-qPCR. Selected negative samples were further subjected to viral metagenomics analysis, using next-generation sequencing (NGS) using Illumina NextSeq 500 platform. Results: To date, 345 patients have been enrolled, with a median age of 65 years, 1.1:1 female:male ratio, and average hospital stay of 5.7 days. Sixty (17.4%) patients had severe disease, defined as admission to intensive care unit (5.5%, n = 19), requiring mechanical ventilation (13.9%, n = 48) or death (4.9%, n = 17). At least one respiratory virus was identified in 195 (56.5%) patients, of which 24 (7%) were co-infections. The most detected viruses were rhinovirus/enterovirus (51%, n = 176), influenza virus (7.5%, comprising 13 A/H3N2, 8 A/H1N1 and 5 influenza B), parainfluenza virus (2.3%, n = 8), respiratory syncytial virus (0.9%, n = 3), metapneumovirus (0.9%, n = 3), coronavirus OC43 (0.6%, n = 2) and adenovirus (0.3%, n = 1). Of 150 (43.5%) negative samples, 48 samples were selected for viral metagenomics analysis. At least one respiratory virus was detected in 14 (29.2%) NGS samples: rhinoviruses (18.8%, n = 9), influenza virus (8.3%, with 3 A/H3N2 and 1 influenza B), and enteroviruses (4.2%, n = 2). No avian influenza virus, MERS-CoV and SARS-CoV was detected in this study. Only 28 (8.1%) patients had significant positive blood cultures, most commonly Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus. Severe disease was independently associated with significant positive blood culture (OR 2.78, 95% CI 1.18–6.59, p = 0.02), but not with any viruses. Conclusion: Rhinovirus/enterovirus and influenza virus are the most frequently detected viruses in adults with SARI, although the clinical significance of the former is not certain. NGS showed that known respiratory viruses play an important etiologic role in unexplained SARIs cases and no emerging respiratory viruses were detected in this study.

Practice and thinking of acute respiratory infection surveillance for the response of emerging respiratory diseases in Shanghai

Shanghai Municipal Center for Disease Control and Prevention has implemented an active comprehensive surveillance project of acute respiratory infections in adults in Shanghai, including influenza like illness (ILI) and severe acute respiratory infection (SARI). By testing and identifying a variety of respiratory pathogens, it was found that influenza viruses were the main pathogens in 172 ILI cases in 2019. The positive rates of influenza A (H1N1) pdm09 virus, influenza A (H3N2) virus and influenza B virus Victoria lineage were 30.81%, 14.53% and 30.55%, respectively. The positive detection of influenza A (H1N1) pdm09 virus peaked in the first quarter. The positive rate of enterovirus/human rhinovirus was 6.40%, with a positive detection peak in the third quarter, while the positive rate of adenovirus was 4.65% with a positive detection peak in the second quarter of the year. Two human coronavirus (HCoV)-OC43 positive samples, 1 HCoV-HKU1 positive sample and 1 HCoV-NL63 positive sample were detected, respectively, and no HCoV-229E positive sample was detected. The detection rate of Staphylococcus aureus was 17.44%, and the detection rate of Klebsiellapneumoniae was 9.88%. Influenza viruses were also the main pathogens in 1 447 SARI cases. The positive rates of influenza A (H1N1) pdm09 virus, influenza A (H3N2) virus and influenza B virus Victoria lineage were 5.46%, 1.73% and 0.30%, respectively. The positive detection of influenza A (H1N1) pdm09 virus (17.50%) peaked in the first quarter. The total positive detection rate of enterovirus/human rhinovirus was 2.97%, the positive detection peaked in the first quarter. The positive rate of Mycoplasma pneumoniae was 3.25% and the positive rate of Legionella was 1.04%. 5 HCoV-229E positive samples, 10 HCoV-OC43 positive samples, 7 HCoV-HKU1 positive samples and 6 HCoV-NL63 positive samples were detected. Eight strains of Staphylococcus aureus, 4 strains of Pseudomonas aeruginosa and 3 strains of Klebsiella pneumoniae were detected after cultures. By implementing the active surveillance, we not only detected a case of human infection with avian influenza A(H7N9) virus in time, but also preliminary understood the pathogenic spectrum characteristics and seasonality of ILI and SARI in Shanghai. In recent years, the surveillance methods have been continuously improved and the number of sentinel hospitals has increased gradually. In particular, for the response to COVID-19, the Surveillance Information Reporting System of Acute Respiratory Infection based on HIS system has been promoted to cover the whole city, which might lay a foundation for the active surveillance and early warning of emerging infectious diseases in the future.

Etiologic and epidemiologic features of acute respiratory infections in adults from Shanghai, during 2015-2017

Objective: To analyze the etiologic and epidemiological characteristics of adult acute respiratory infections in Shanghai during 2015-2017. Methods: Data was collected from outpatients with acute respiratory infections who visited the Fever Clinics in three hospitals of different levels in three administrative regions of Shanghai, from 2015 to 2017. Basic information and nasopharyngeal swabs were collected from cases in line with the inclusion criteria. Multiplex RT-PCR and bacterial cultures were performed to detect the respiratory pathogens. Results: A total of 806 individuals were enrolled from 2015 to 2017. Respiratory pathogens were identified in 73.45% (592/806) of the cases, with the virus detection rate as 66.75% (538/806). It was found that the major respiratory pathogens for virus detection were influenza A in 326 (40.45%), influenza B in 116 (14.39%), rhinovirus/enterovirus in 39 (4.84%) of the cases. The overall detection rate of bacteria was 16.13% (130/806), including Klebsiella pneumoniae in 90 (11.17%) cases, Staphylococcus Aureus in 46 (5.71%) cases. Other kind of bacteria were not detected in our study. The detection rates on Mycoplasma pneumoniae was 5.33% (43/806) and on Chlamydia pneumonia was 0.37% (3/806). Co-infection with multiple pathogens was detected in 18.61% (150/806) of the cases, including 135 with double infection (accounting for 90.00%), 14 with triple infection and 1 with quadruple infection (accounted for 9.33% and 0.67%, respectively). Among the 150 cases with co-infections, the main identified pathogens were influenza A, Klebsiella pneumoniae, Staphylococcus aureus, and Mycoplasma pneumoniae. Pathogens of acute respiratory infections that identified among the outpatients from the Fever Clinics at different time, region or population, the characteristics were different (P<0.001). Conclusions: In 2015-2017, outpatients with acute respiratory infections in Shanghai were mainly caused by influenza virus or other viruses, however dynamically with its composition, time, region and characteristics of the population. It is necessary to strengthen and combine related medical and preventive services and to develop the appropriate strategies regarding clinical diagnosis and treatment.

Viral pathogens associated with acute respiratory illness in hospitalized adults and elderly from Zagreb, Croatia, 2016 to 2018.

AimsTo investigate the viral etiology of acute respiratory infection (ARI) in hospitalized adults and elderly patients in Croatia, compare the prevalence of detected viruses, and to determine clinical characteristics and seasonal occurrence of investigated infections.MethodsFrom January 2016 to June 2018, a total of 182 adult patients presented with symptoms of ARI and admitted to the hospital were tested for 15 respiratory viruses by multiplex reverse‐transcription polymerase chain reaction. Clinical data were collected by retrospective analysis of the patient's chart.ResultsA virus was identified in 106 (58.5%) of the patients. The most commonly detected virus was influenza virus (41.5%), followed by respiratory syncytial virus (13.8%), human metapneumovirus (13.0%), parainfluenza viruses (12.2%), rhinoviruses (11.4%), adenovirus and coronaviruses with equal frequencies (3.3%), and enterovirus (1.6%). The serum level of C‐reactive protein and white blood cell count were significantly lower in patients with respiratory viruses identified when compared with those in whom no virus was detected (P < 0.001 and P = 0.007, respectively). There were no differences in clinical symptoms according to the type of the detected virus, except for more frequent illness exposure recall for influenza infection ( P = 0.010). Influenza, parainfluenza, and pneumoviruses were detected mostly in winter months, while rhinoviruses in autumn and spring.ConclusionsIn addition to influenza, pneumoviruses, rhinoviruses, and parainfluenza viruses play an important role in etiology of ARIs in adults. Fast and accurate laboratory diagnosis for respiratory viruses in routine practice is needed for clinicians optimally manage patients with ARI and potentially avoid the unnecessary use of antimicrobial drugs.

1633. A Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection in Adults and Children in Emergency Department and Urgent Care Settings (MITIGATE Trial)

BackgroundAntibiotics are prescribed in approximately half of emergency department (ED) and urgent care center (UCC) visits for antibiotic inappropriate or presumed viral acute respiratory infection (ARI). Unnecessary antibiotic use increases adverse events, antibiotic resistance, and healthcare costs. Antibiotic stewardship in the ED and UCC requires specific implementation tailored to these unique settings. Objective. To evaluate the comparative effectiveness of patient and provider education adapted for the acute care setting (adapted intervention) to an intervention with behavioral nudges and individual peer comparisons (enhanced intervention), on reducing inappropriate antibiotic use for ARI in EDs and UCCs.MethodsPragmatic, cluster randomized clinical trial conducted in 3 academic health systems (1 pediatric-only, 2 serving adults and children) that included 5 adult and pediatric EDs and 4 UCCs. Sites were block randomized by health system, and providers at each site assigned to receive the adapted or enhanced intervention. Implementation science strategies were employed to tailor interventions at each site. The main outcome was the proportion of antibiotic inappropriate ARI diagnosis visits that received an antibiotic. We estimated a hierarchical mixed effects logistic regression model for visits that occurred between November and February for 2016–2017 (baseline) and 2017–2018 (intervention), controlling for organization and provider fixed effects.ResultsAcross all sites, there were 45,160 ARI visits among 534 providers, with overall antibiotic prescribing at 2.6%; the pediatric-only system had a lower baseline rate (1.6%) compared with the other 2 systems (5.0% and 7.1%), P < 0.001). Despite the unusually low rate, we found a significant reduction in inappropriate prescribing after adjusting for health-system and provider-level effects from 2.6% to 1.4 % (odds ratio 0.52; 0.38–0.72). Reductions in prescribing between the 2 interventions were in the expected direction, but not significantly different (P < 0.062).ConclusionImplementation of antimicrobial stewardship for ARI is feasible and effective in the ED and UCC settings. The enhanced behavioral nudging methods were not more effective in high-performance settings.Disclosures All authors: No reported disclosures.

1813. Development and Validation of Novel Ambulatory Antibiotic Stewardship Metrics

BackgroundOver 260 million antibiotic courses are prescribed in ambulatory settings per year in the United States: 41% of which are for acute respiratory tract infections (ARTI). Over 50% of these antibiotic courses are inappropriate. However, interventions to improve ambulatory prescribing are little studied, and metrics to track antibiotic use are not well validated.MethodsTo validate metrics for ARTIs in adults, we conducted a retrospective cohort study from January 1, 2016 to December 31, 2016 at 32 primary care practices. We randomly selected 1,200 office visits with a coded respiratory tract diagnosis and determined by medical record review the proportion of visits in which antibiotic prescription was inappropriate using modified Infectious Diseases Society of America treatment guidelines. We determined clinic and provider characteristics associated with inappropriate prescribing. By linear regression, we also determined the aggregate metrics best correlated with inappropriate antibiotic prescribing.ResultsAn antibiotic was prescribed in 37% of visits in which a respiratory tract diagnosis was coded. Of these prescriptions, 69% were inappropriate. Demographics associated with inappropriate prescribing included advance practice provider vs. physician (72% vs. 58%, P = 0.02), family medicine vs. internal medicine (75% vs. 63%, P = 0.01), board certification after vs. before 1997 (75% vs. 63%, P = 0.02), and practice in a non-teaching vs. teaching clinic (73% vs. 51%, P < 0.001). Rate of antibiotic prescribing in visits where any respiratory tract diagnosis was coded (R2 = 0.23, P < 0.001) and rate of antibiotic prescribing in visits where a respiratory tract diagnosis that almost never requires an antibiotic was coded (R2 = 0.24, P < 0.0001) were most strongly correlated with inappropriate prescribing.ConclusionRate of antibiotic prescribing in visits where any respiratory tract diagnosis was coded and rate of antibiotic prescribing in visits where a respiratory tract diagnosis that almost never requires an antibiotic was coded may be useful proxies to estimate the rate of inappropriate prescribing for ARTIs. This study could inform ambulatory antibiotic benchmarking metrics and interventions to decrease inappropriate antibiotic prescribing for ARTIs in ambulatory settings.Disclosures All authors: No reported disclosures.

Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention.

Acute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with ARTI. A narrative literature review of evidence about appropriate antibiotic use for ARTI in adults was conducted. The most recent clinical guidelines from professional societies were complemented by meta-analyses, systematic reviews, and randomized clinical trials. To identify evidence-based articles, the Cochrane Library, PubMed, MEDLINE, and EMBASE were searched through September 2015 using the following Medical Subject Headings terms: "acute bronchitis," "respiratory tract infection," "pharyngitis," "rhinosinusitis," and "the common cold." Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected. Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis. Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39°C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening). Clinicians should not prescribe antibiotics for patients with the common cold.

Cost-effectiveness of procalcitonin-guided antibiotic therapy for outpatient management of acute respiratory tract infections in adults.

Two clinical trials suggest that procalcitonin-guided antibiotic therapy can safely reduce antibiotic prescribing in outpatient management of acute respiratory tract infections (ARTIs) in adults. Yet, it remains unclear whether procalcitonin testing is cost-effective in this setting. To evaluate the cost-effectiveness of procalcitonin-guided antibiotic therapy in outpatient management of ARTIs in adults. Cost-effectiveness model based on results from two published European clinical trials, with all parameters varied widely in sensitivity analyses. Two hypothetical cohorts were modeled in separate trial-based analyses: adults with ARTIs judged by their physicians to require antibiotics and all adults with ARTIs. Procalcitonin-guided antibiotic therapy protocols versus usual care. Costs and cost per antibiotic prescription safely avoided. We estimated the health care system willingness-to-pay threshold as $43 (range $0–$333) per antibiotic safely avoided, reflecting the estimated cost of antibiotic resistance per outpatient antibiotic prescribed. In the cohort including all adult ARTIs judged to require antibiotics by their physicians, procalcitonin cost $31 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored compared to usual care was 58.4 % in a probabilistic sensitivity analysis. In the analysis that included all adult ARTIs, procalcitonin cost $149 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored was 2.8 %. Procalcitonin-guided antibiotic therapy for outpatient management of ARTIs in adults would be cost-effective when the costs of antibiotic resistance are considered and procalcitonin testing is limited to adults with ARTIs judged by their physicians to require antibiotics.

The Development and Validation of a Multidimensional Sum-Scaling Questionnaire to Measure Patient-Reported Outcomes in Acute Respiratory Tract Infections in Primary Care: The Acute Respiratory Tract Infection Questionnaire

ObjectivePatient-reported outcomes are seldom validated measures in clinical trials of acute respiratory tract infections (ARTIs) in primary care. We developed and validated a patient-reported outcome sum-scaling measure to assess the severity and functional impacts of ARTIs. MethodsQualitative interviews and field testing among adults with an ARTI were conducted to ascertain a high degree of face and content validity of the questionnaire. Subsequently, a draft version of the Acute Respiratory Tract Infection Questionnaire (ARTIQ) was statistically validated by using the partial credit Rasch model to test dimensionality, objectivity, and reliability of items. Test of known groups’ validity was conducted by comparing participants with and without an ARTI. ResultsThe final version of the ARTIQ consisted of 38 items covering five dimensions (Physical-upper, Physical-lower, Psychological, Sleep, and Medicine) and five single items. All final dimensions were confirmed to fit the Rasch model, thus enabling sum-scaling of responses. The ARTIQ scores in participants with an ARTI were significantly higher than in those without ARTI (known groups’ validity). ConclusionA self-administered, multidimensional, sum-scaling questionnaire with high face and content validity and adequate psychometric properties for assessing severity and functional impacts from ARTIs in adults is available to clinical trials and audits in primary care.

Corticosteroids for acute and subacute cough following respiratory tract infection: a systematic review

Cough associated with acute respiratory tract infection (RTI) is one of the most common problems managed in primary care. Despite minimal evidence for the use of antibiotics, they continue to be prescribed at great cost and are a significant cause of emerging bacterial resistance. To carry out a systematic review of randomized controlled trials to evaluate the effect of corticosteroid therapy in otherwise-healthy adults with acute RTI. Seven electronic databases and five ongoing trial registers were searched. Studies were eligible if they compared the use of any corticosteroid treatment against a control group in adults with an acute (<3 weeks) or subacute (<8 weeks) cough associated with an RTI but no asthma. Primary outcomes were differences in mean cough and other symptom scores. Secondary outcomes included adverse effects, subsequent diagnosis of asthma and patient satisfaction. Four trials (335 participants) investigating the effects of inhaled corticosteroids were identified. None investigated the use of oral corticosteroids. Results were mixed, with two reporting equivalence and two reporting benefits for mean cough score (P = 0.012) and cough frequency (P = 0.047). One reported additional benefits in non-smokers. Adverse events were rare and there were no data on patient satisfaction or the subsequent diagnosis of asthma. Most trials were of unclear risk of bias. Study outcomes were too heterogeneous to meta-analyse. There is insufficient evidence to recommend the routine use of inhaled corticosteroids for acute RTI in adults. However, some trials have shown benefits, suggesting the need for further high-quality, adequately powered trials.

Novel coronavirus associated with severe respiratory disease: Case definition and public health measures

Two cases of rapidly progressive acute respiratory infection in adults associated with a novel coronavirus have generated an international public health response. The two infections were acquired three months apart, probably in Saudi Arabia and Qatar. An interim case definition has been elaborated and was published on the World Health Organization website on 25 September 2012.