Multiplex Respiratory Viral Panel Use In The Intensive Care Unit And Its Effect On Antibiotic Usage And Patient Outcomes.

Background:

Pneumonia is the top cause of mortality of all age groups in the United States. Patients admitted to the intensive care unit (ICU) have a high use of empiric antibiotics for treatment. Some of these infections can be viral. Because antiviral therapies are limited to certain viruses, it is argued that identification of viruses for which there is no therapy does not alter patient management. Our study looks at the use of the multiplex respiratory viral panel (MRVP) test and its effect on antibiotic usage and outcomes in the ICU.

Methods:

Retrospective cohort. Single site, 1300 bed university hospital. All ICU patients with diagnosis of pneumonia who had an MRVP from November 2011 to June 2015 were included. Prisoners, patients less than 18 years old and patients with a bacterial pneumonia were excluded. Categorical variables assessed using the chi-square test. Continuous variables described using the Student’s t-test. All data analyzed using JMP statistical software.

Results:

11,991 patients had an MRVP performed between November 2011 and June 2015. After inclusion and exclusion criteria we had 2,068 patients; 535 patients with a positive and 1533 with a negative MRVP. 425 from each group were randomized for inclusion.

Demographics		MRVP NEGATIVE (n=425)	MRVP POSITIVE (n=425)
Gender	Male	46.2% (n=229)	51.1% (n=217)
	Female	53.8% (n=196)	48.9% (n=208)
Race	White	75.7% (n=322)	75.7% (n=322)
	Black	18.2% (n=77)	18.8% (n=80)
Mean age at visit (SD)		57.6 (15.8)	57.6 (16.2)
Mean Body Mass Index (SD)		30.4 (9.3)	29.8 (9.9)
Charlson Comorbidity Score (SD)		5.84 (5.45)	5.38 (4.81)
Chronic Lung Disease (YES)		47.7% (n=203)	47.7% (n=203)

Outcomes	MRVP NEGATIVE (n=425)	MRVP POSITIVE (n=425)	p-value
Mean duration of antibiotic use	17.69 days	14.47 days	0.0003
Mean length of ICU stay	12.37 days	10.44 days	0.0376
Mean length of hospital stay	10.83 days	9.44 days	0.0213
30 day attributable mortality	28.5%	18.12%	0.0004

Conclusion:

Patients who had a positive MRVP had a shorter duration of aggregate antibiotic use, mean length of ICU and hospital stay and reduced 30-day attributable mortality. This study might indicate a utility of the MRVP for antimicrobial management in the ICU. Further studies are indicated
.