1282. Impact of RSV Testing on Antibiotic Use in Adults Presenting for Emergency Care
Session: Poster Abstract Session: Clinical Infectious Diseases: Respiratory Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • RSV_IDweek_2016_FINAL.pdf (755.0 kB)
  • Background: Respiratory syncytial virus (RSV) is an under-recognized cause of respiratory illness in adults. The availability of combined influenza/RSV PCR-based testing has the potential to decrease antibiotic use in patients presenting with acute respiratory illness. Study objectives were to 1) describe adult RSV incidence and 2) assess impact of RSV+ on antibiotic utilization.

    Methods: We retrospectively analyzed adult (≥18 y) patients tested for RSV/influenza (Cepheid® Xpert RSV/influenza PCR) in our 1100-bed 2-hospital community-based healthcare system during Oct 2015 – Apr 2016. We collected emergency department (ED) visit (190,000/year) and inpatient data, including demographics, disposition, and antibiotic use (≥1 doses, IV or PO). The primary outcome was antibiotic utilization.

    Results: RSV/flu testing occurred during 3082 adult visits; of these 943 (31%) were discharged from the ED, 1892 (61%) were inpatient, and 247 (8%) were observation (OBS) visits. Overall 79% of tests were negative; of these, 74% of visits resulted in admission to inpatient or OBS status. Viral testing was positive for 663 (21%): 100 (3%) RSV+, 562 (18%) flu+, and 1 RSV+/flu+. RSV+ patients were more likely to be admitted (79% vs. 48%, p<0.001), and if admitted to receive antibiotics (81% vs. 42%, p<0.001), than flu+ patients; 60% of RSV–/flu– patients received antibiotics. ED discharges (viral+ only) had a 5% rate of antibiotic use. Flu positivity decreased after age 59, while RSV positivity increased (Figure). Total number/proportion of RSV cases were similar in the ≥65y age group (55; 31% of all RSV+) to the <5y age group (66; 38% of RSV+).

    N

    Inpt/OBS
    n(%)

    Inpt/OBS w/ Abx
    (%)

    ED discharges w/ Abx
    (%)

    RSV+

    100

    79 (79)

    80.7

    9.5

    Flu+

    562

    267 (48)

    41.9

    3.7

    RSV-/Flu-

    2419

    1792 (74)

    59.7

    8.9

    Conclusion: Overall RSV positivity in adults was low, but increased with age and in ≥65y group was comparable to RSV seen in young children. Flu positivity declined after age 59 in this season in which H1N1 predominated. Compared to RSV–/flu– patients, RSV+ patients were more frequently admitted and received antibiotics; whether this reflects inappropriate use vs. bacterial co- or super-infection in this older, highly comorbid population requires further study.

    Marci Drees, MD, MS1,2,3, Tom Laughery, BS1, Sarojini Misra, MS, SM (ASCP), SM (AAM)4 and Ryan C. Arnold, MD1,5, (1)Christiana Care Value Institute, Newark, DE, (2)Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, (3)Medicine, Christiana Care Health System, Newark, DE, (4)Christiana Care Health System, Newark, DE, (5)Emergency Medicine, Christiana Care Health System, Newark, DE

    Disclosures:

    M. Drees, None

    T. Laughery, None

    S. Misra, None

    R. C. Arnold, 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.