Virginia Research Day 2021

Medical Resident Research Cl inical

12 Respiratory Viral Panels Can Contribute to Antibiotic Stewardship

Jasmine Jackson-Akers, DO; Samuel Thomas, DO; Balaji Desai, MD Corresponding author: michael.moore1@LPNT.net

SOVAH Health Internal Medicine Residency Program

Introduction: Antibiotic (AB) stewardship includes the correct treatment for an infection at the correct dose for an optimal duration. For serious respiratory tract (RT) infections, broad spectrum antibiotics are usually given until a causative infectious agent can be identified when treatment can be made specific to the cause. Unfortunately, often broad-spectrum ABs are not changed to the specific cause which increases the cost of care and the risk of antibiotic resistance. Causative agent identification is critical to prescribing correct treatment. RTs can be caused by viruses, bacteria, or fungi which can be identified by culture or antigen testing. Since 2015, respiratory viral panels (RP) have been used to determine causes of respiratory infections. Original viral RPs only distinguished influenza A from influenza B; however, current RPs can detect simultaneously influenza A, influenza B, Respiratory Syncytial Virus (RSV), Adenovirus, and subsets of Coronavirus. At Sovah Health-Danville, the Biofire FilmArray Torch System RP is used. It detects Adenovirus, Coronavirus subspecies, Human Metapneumovirus, Human Rhinovirus/enterovirus, Influenza A, Influenza B subspecies, Parainfluenza virus 1-4, and RSV,

plus Bordetella pertussis, Bordetella parapertussis, Chlaymdia pneumoniae, and Mycoplasma pneumoniae. This study was done to determine if RP results were used to prescribe the most appropriate cause specific treatment to improve antibiotic stewardship. Methods: A retrospective review of de-identified patient EMR data of patients admitted with a respiratory infection on whom a RP was done (February 3- March 18, 2020) to test for a viral cause. Data collected included patient demographics and administration of empiric antibiotics before RP and afterwards. Inclusion criteria were patients 18 years or older with a respiratory tract infection on whom an RP was done. Exclusion criteria were < 18 years old, no respiratory infection, and those with a bacterial pneumonia on admission. Results: During the 6 weeks, 55 patients were analyzed. Mean age was 59.6 years (19-88). Sixty three percent were Caucasian; African American, 24%, and unknown, 13%. All received initial antibiotics. 27 of 55 (49%) with a positive RP for a viral respiratory infection continued to receive

antibiotics after a positive RP for 3 to 7 days, while the antibiotic was appropriately discontinued in 51%. Three of the 55 patients had bacterial infections including Chlamydia pneumoniae and Mycoplasma pneumoniae; these patients were not included in the analysis. Conclusion: This study demonstrated that about half of the patients presenting with a RP diagnosed viral respiratory tract infection did not have their antibiotics discontinued when the viral etiology was reported. This increased the risk for increasing antibiotic resistance, AB side effects, and the cost of care. This study demonstrates the potential value of a RP in antibiotic stewardship. In conclusion, close attention should be paid to the results of RP when ordered so that unnecessary antibiotics can be avoided in order to provide better and safer care.

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