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1334
Randomized Clinical Trial of Viral Testing and Serum Procalcitonin to Reduce Antibiotic Use for Respiratory Infections

Session: Oral Abstract Session: Clinical Trials
Saturday, October 11, 2014: 11:15 AM
Room: The Pennsylvania Convention Center: 109-AB
Background: Lower respiratory tract illness (LRTI) is a common cause of hospitalization and linked to antibiotic overuse especially for viral infections. Recent data suggest that serum procalcitonin (PCT) is elevated in bacterial infection and can be used to safely guide antibiotic therapy for LRTI. Multiplex PCR can rapidly identify many viruses but its effect on patient care is uncertain. Thus, we evaluated viral testing in combination with PCT to reduce unnecessary antibiotic use in hospitalized adults with non-pneumonic LRTI.

Methods: After informed consent, patients hospitalized with LRTI were randomly assigned to a standard of care group (routine Flu & RSV PCR performed at provider’s discretion and no PCT) or an intervention group (Multiplex RT-PCR (FilmArray) and PCT obtained and released to providers with a PCT algorithm). Exclusions included ICU care, hypotension, >15% bands or a definite infiltrate on CXR. The primary outcome was comparison of antibiotic use in the two groups.

Results: From October 2013-April 2014, 300 illnesses were randomized. Patients in both arms were well matched for comorbidities and admitting diagnoses. Viruses were identified in 44% and 21%, p=.001 of intervention and nonintervention subjects, respectively. PCT was < 0.25 ug/ml (antibiotics not recommended per algorithm) in 86% of subjects in the intervention group. There were no significant differences in length of stay (LOS), total antibiotic days and discharge on antibiotic. Subjects with PCT > 0.25 ug/ml had significantly longer LOS and increased antibiotic use.  Viral positive/low PCT subjects were less frequently discharged on antibiotics compared to nonintervention patients (18% vs. 38%, P=0.02) and had significantly less IV antibiotic use (p=0.008). Compared to the same patient population from a previous study (2008-2012), total antibiotic use decreased from 83% to 76% (p=0.02) suggesting a possible study effect. In a survey of physicians, 92% indicated that viral and PCT testing frequently or sometimes changed their management.

Conclusion: Despite being well accepted, the combination of viral and PCT testing did not result in overall reduced antibiotic use in the intervention group. However, modest reductions in antibiotic use in viral positive/low PCT subjects suggest this approach deserves further study.

Angela Branche, MD1, Edward Walsh, MD, FIDSA2, Ann Falsey, MD3, Roberto L. Vargas, MD4 and Barbara Hulbert, ASCP4, (1)Department of Medicine, Division of Infectious Diseases, University of Rochester Medical Center, Rochester, NY, (2)University of Rochester School of Medicine and Den, Rochester, NY, (3)University of Rochester, Rochester, NY, (4)Department of Pathology, Rochester General Hospital, Rochester, NY

Disclosures:

A. Branche, None

E. Walsh, Clearpath Incorporated: Consultant, Consulting fee
Alios Biopharma: Consultant, Consulting fee

A. Falsey, Regeneron: Consultant, Consulting fee
Hologic: Consultant, Consulting fee
Sanofi Pasteur: Research Contractor, Research grant
AstraZeneca: Research Contractor, Research grant
ADMA Biologic Inc: Research Contractor, Research grant

R. L. Vargas, None

B. Hulbert, None

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