Your browser doesn't support javascript.
loading
The effect of respiratory viral assay panel on antibiotic prescription patterns at discharge in adults admitted with mild to moderate acute exacerbation of COPD: a retrospective before- after study.
Tickoo, Mayanka; Ruthazer, Robin; Bardia, Amit; Doron, Shira; Andujar-Vazquez, Gabriela M; Gardiner, Bradley J; Snydman, David R; Kurz, Sebastian G.
Afiliação
  • Tickoo M; Department of Internal Medicine, Division of Pulmonary, Sleep and Critical Care, Yale School of Medicine, New Haven, CT, USA. mayanka.tickoo@yale.edu.
  • Ruthazer R; Biostatistics, Epidemiology, Research, and Design Center, Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, USA.
  • Bardia A; Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA.
  • Doron S; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
  • Andujar-Vazquez GM; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
  • Gardiner BJ; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
  • Snydman DR; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
  • Kurz SG; Pulmonary and Critical Care Division, Mount Sinai National Jewish Respiratory Institute, New York, NY, USA.
BMC Pulm Med ; 19(1): 118, 2019 Jul 01.
Article em En | MEDLINE | ID: mdl-31262278
ABSTRACT

BACKGROUND:

Despite well-defined criteria for use of antibiotics in patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), their overuse is widespread. We hypothesized that following implementation of a molecular multiplex respiratory viral panel (RVP), AECOPD patients with viral infections would be more easily identified, limiting antibiotic use in this population. The primary objective of our study was to investigate if availability of the RVP decreased antibiotic prescription at discharge among patients with AECOPD.

METHODS:

This is a single center, retrospective, before (pre-RVP) - after (post-RVP) study of patients admitted to a tertiary medical center from January 2013 to March 2016. The primary outcome was antibiotic prescription at discharge. Groups were compared using univariable and multivariable logistic-regression.

RESULTS:

A total of 232 patient-episodes were identified, 133 following RVP introduction. Mean age was 68.1 (pre-RVP) and 68.3 (post-RVP) years respectively (p = 0.88). Patients in pre-RVP group were similar to the post-RVP group with respect to gender (p = 0.54), proportion of patients with BMI < 21(p = 0.23), positive smoking status (p = 0.19) and diagnoses of obstructive sleep apnea (OSA, p = 0.16). We found a significant reduction in antibiotic prescription rate at discharge in patients admitted with AECOPD after introduction of the respiratory viral assay (pre-RVP 77.8% vs. post-RVP 63.2%, p = 0.01). In adjusted analyses, patients in the pre-RVP group [OR 2.11 (CI 1.13-3.96), p = 0.019] with positive gram stain in sputum [OR 4.02 (CI 1.61-10.06), p = 0.003] had the highest odds of antibiotic prescription at discharge.

CONCLUSIONS:

In patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), utilization of a comprehensive respiratory viral panel can significantly decrease the rate of antibiotic prescription at discharge.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Alta do Paciente / Prescrições de Medicamentos / Infecções Respiratórias / Doença Pulmonar Obstrutiva Crônica / Antibacterianos Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Alta do Paciente / Prescrições de Medicamentos / Infecções Respiratórias / Doença Pulmonar Obstrutiva Crônica / Antibacterianos Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2019 Tipo de documento: Article