1866. Role of Respiratory Virus Panels in Antimicrobial Stewardship in Immunocompromised Patients
Session: Poster Abstract Session: Antibiotic Stewardship: Diagnostics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Mercuro_Biofire_IDWeek2016.pdf (298.3 kB)
  • Background: Respiratory virus (RV) panels have emerged as a novel method for detecting influenza and pathogens known to cause influenza-like-illness which may have clinical relevance in immunocompromised patients. The purpose of this study was to describe turnaround time (TAT) and antimicrobial stewardship interventions associated with in-house RV testing compared to send-out testing in an immunocompromised population.

    Methods: This was an IRB-approved, pretest-posttest quasiexperiment at an 802-bed hospital in Detroit MI. Inpatients ≥18 years of age with solid organ and bone marrow transplant, or those with immunocompromising conditions in the intensive care unit (ICU) were included. Collection periods were RV season 1 (RVS1), Oct. 2014—Mar. 2015 (send-out testing), and RV season 2 (RVS2), Oct. 2015—Apr. 2016 (in-house testing). TAT was measured from specimen collection to result; time to intervention (TTI) was measured from specimen collection to change in drug therapy. RVS1 and RVS2 were compared using bivariate tests.

    Results: 131 patients were included, 56 RVS1, 75 RVS2. 61.1% of patients were clinically diagnosed with pneumonia, 27.5% of which was microbiologically confirmed. The in-house panel reduced TAT and TTI, and had more positive testing (Table 1). Most common pathogens were influenza (8 in RVS1, 5 in RVS2), coronavirus (0 and 11), and rhinovirus (1 and 7). Differences were not observed between groups for frequency or type of intervention or outcome.

    Conclusion: Diagnostic yield and TTI were improved by in-house RV testing, but this did not impact length of stay (LOS), duration of therapy (DOT), or frequency of drug-related interventions. The majority of interventions were discontinuation of oseltamivir, with minimal impact on antibacterial use.

    Outcome

    RVS1 (n=56)

    RVS2 (n=75)

    P

    Positive test, n (%)

    11 (19.6)

    32 (42.7)

    < 0.01

    TAT, median hrs (IQR)

    47 (11—61)

    6 (3.5—11)

    < 0.001

    TTI, median hrs (IQR)

    52 (38—69)

    14( 9—30)

    < 0.001

    DOT, median days (IQR)

    4 (2—7)

    4 (2—7)

    0.958

    LOS, median days (IQR)

    8 (4—14)

    6 (3—13.5)

    0.491

    Intervention, n (%)

    20 (35.7)

    23 (30.6)

    0.543

    Start antiviral

    3 (5.4)

    7 (9.3)

    0.515

    Discontinue oseltamivir

    14 (25.0)

    13 (17.3)

    0.283

    Discontinue antibiotic

    2 (3.6)

    4 (5.3)

    0.633

    Adjust immunosuppression

    1 (1.8)

    2 (2.7)

    0.739

     

     

     

     

     

     

     


    Nicholas Mercuro, PharmD1, Rachel M Kenney, PharmD2, Robert Tibbetts, Ph.D. D(ABMM), F(CCM)1, Linoj Samuel, PhD., D(ABMM)1 and Susan L Davis, PharmD1,3, (1)Henry Ford Hospital, Detroit, MI, (2)Pharmacy, Henry Ford Hospital, Detroit, MI, (3)Wayne State University College of Pharmacy, Detroit, MI

    Disclosures:

    N. Mercuro, None

    R. M. Kenney, None

    R. Tibbetts, None

    L. Samuel, None

    S. L. Davis, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.