210. Improved Antimicrobial Utilization in the Emergency Department: Impact of a Point of Care Polymerase Chain Reaction Test for The Rapid Detection Influenza
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Influenza PCR Poster.pdf (320.9 kB)
  • Background: Due to poor sensitivity, the FDA mandated that rapid influenza antigen (IAT) must be phased out by 2018. At our institution an on-site rapid influenza PCR (PCR) was implemented in emergency departments (ED) at the start of the 2016-2017 influenza season. The purpose of this study was to examine the impact of influenza PCR testing on antimicrobial utilization in the ED.

    Methods: This multicenter quasiexperimental study included adults over the age of 50 who were tested for influenza, and discharged from the ED. Subjects were matched 2:1 by age, sex, month of testing, and ED site. The pre-implementation group had IAT (Jan-Apr 2016) and the post-implementation had PCR testing (Jan-Apr 2017). The primary outcome was antiviral utilization. Other outcomes included diagnostic yield, test turnaround time (TAT), receipt of antibiotics, and 30-day revisit.

    Results: The PCR group of 116 patients (pts) were matched to 232 pts in IAT group (Table 1). Positive results for influenza were reported in 37.9% of PCR versus 18.1% of IAT groups (p<0.001); TAT 0.95 (0.75-1.4) hours in PCR vs. 0.60 (0.40-0.85) hours in IAT group (P<0.001). Oseltamivir was initiated in the ED in 21% of PCR vs. 11% of IAT group (p<0.001). An additional 28% in PCR group received oseltamivir at ED discharge vs. 15% in IAT group (p=0.004). Antibiotics were administered in the ED to 8% in PCR group vs. 15% in the IAT group. A positive influenza test was associated with less antibiotic use OR 0.454 (95% CI 0.213-0.967), while abnormal chest radiograph (CXR) and WBC was associated with increased antibiotic use OR 3.667 (95% CI 1.743-7.715). The 30-day revisit was 3.8% and 10.8% in the PCR vs. IAT groups respectively (p=0.034).

    Conclusion: Replacing IAT with PCR testing increased diagnostic yield for influenza and receipt of oseltamivir and decreased antibiotic utilization in the ED. Independent predictors for antibiotic use were abnormal CXR and WBC, while positive influenza testing was protective.

    Table 1: Characteristics of study population

    Variables

    PCR (n=116)

    Antigen (n=232)

    p-value

    Age

    59 (53-64)

    58 (54-65)

    0.522

    Male sex

    50 (43.9)

    99 (42.9)

    0.860

    Symptom duration (days)

    2 (1-4)

    2 (1-4)

    0.870

    Charlson Score

    1 (0-2)

    2 (0-4)

    0.206

    WBC

    6.3 (5.2-8.6)

    6.7 (5.1-8.8)

    0.739

    Normal CXR

    81 (87.1)

    164 (83.2)

    0.398

    Jonathan Williams, MD1, Nicholas Mercuro, PharmD2, Amit Vahia, M.D., M.P.H.3, Hira Rizvi, MD4, Mujtaba Hameed, BS*5, Odaliz Abreu-Lanfranco, MD6, Pallavi Bhargava, MD1, Linoj Samuel, PhD., D(ABMM)7 and George Alangaden, MD, FIDSA6, (1)Infectious Disease, Henry Ford Healthcare System, Detroit, MI, (2)Infectious Diseases Pharmacotherapy, Wayne State University, Detroit, MI, (3)School of Public Health - Epidemiology, University of Michigan, Ann Arbor, MI, (4)Infectious Disease, Henry Ford Health System, Detroit, MI, (5)Infectious Diseae, Henry Ford Health System, Detroit, MI, (6)Infectious Diseases, Henry Ford Health System, Detroit, MI, (7)Microbiology, Henry Ford Hospital, Detroit, MI

    Disclosures:

    J. Williams, None

    N. Mercuro, None

    A. Vahia, None

    H. Rizvi, None

    M. Hameed, None

    O. Abreu-Lanfranco, None

    P. Bhargava, None

    L. Samuel, None

    G. Alangaden, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.