719. The Respiratory Pathogen Panel and Antibiotic Utilization in the Emergency Department
Session: Poster Abstract Session: Respiratory Infections: Viral
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • DTaupin_IDWPOSTER.pdf (350.0 kB)
  • Background:

    The multiplex polymerase chain reaction respiratory pathogen panel (RPP) is used frequently in emergency departments (EDs) for the rapid identification of viruses and atypical bacteria of the respiratory tract.  Its clinical value is unclear, as numerous studies have demonstrated that its use has a limited impact on antibiotic prescribing. We aimed to describe the relationship between RPP results and antibiotic prescribing rates for ED patients in our large academic medical center.  

    Methods:

    We retrospectively analyzed the charts of 1,061 patients aged 18-90 who were treated and released from two EDs from 1/1/2015 to 1/31/2018 and underwent RPP testing.  Patients with evidence of bacterial infection were excluded based on RPP detection of atypical bacteria and microbiological analysis of blood, urine, wound, and sputum specimens. The results of the RPP and the rates of subsequent respiratory pathogen-directed antibiotic prescribing (including ED and outpatient pharmacy orders) were compared. 

    Results:

    Antibiotic prescription rates were 21.5% in patients who tested negative for any respiratory virus, compared to 14.5% in patients who tested positive (OR 0.70, p<0.01).  When positive RPPs were subdivided based on virus type (influenza and non-influenza) and compared to negative RPPs, only influenza-detection was associated with a significant reduction in antibiotic prescriptions (table 1).

    Conclusion:

    In our study population, the presence of a respiratory virus detected by the RPP was correlated with a significant decrease in antibiotic prescribing.  This effect was largely driven by influenza detection.  This demonstrates that at our institution, the RPP may have a role in reducing unnecessary antibiotic utilization, but providers need further guidance in the interpretation of non-influenza respiratory virus positivity.

      Table 1. Antibiotic prescription rates by RPP result, subdivided by virus type

    RPP Result

    N

    No. of patients given antibiotics

    Odds Ratio (95% CI)

    P-value

    Negative

    628

    135 (21.5%)

    Reference

    Positive

    433

    63 (14.5%)

    0.70 (0.56-0.88)

    <0.01

         Influenza*

    169

    20 (11.8%)

    0.49 (0.30-0.81)

    <0.01

         Non-influenza virus(es)

    264

    43 (16.3%)

    0.71 (0.49-1.04)

      0.08

       

    *Includes RPPs that were positive for multiple viruses if influenza was present

     

    Daniel Taupin, MD1, Anna Stachel, MPH, CIC2, Dan Ding, MA1, Sarah Hochman, MD2 and Michael Phillips, MD2, (1)NYU Langone Medical Center, New York, NY, (2)Infection Prevention and Control, NYU Langone Medical Center, New York, NY

    Disclosures:

    D. Taupin, None

    A. Stachel, None

    D. Ding, None

    S. Hochman, None

    M. Phillips, None

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