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
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...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12890-019-0872-0 |
| _version_ | 1818302014563549184 |
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| author | Mayanka Tickoo Robin Ruthazer Amit Bardia Shira Doron Gabriela M. Andujar-Vazquez Bradley J. Gardiner David R. Snydman Sebastian G. Kurz |
| author_facet | Mayanka Tickoo Robin Ruthazer Amit Bardia Shira Doron Gabriela M. Andujar-Vazquez Bradley J. Gardiner David R. Snydman Sebastian G. Kurz |
| author_sort | Mayanka Tickoo |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T05:32:10Z |
| format | Article |
| id | doaj.art-ffbbd8fd6ccc480bbbe2e15678709551 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-13T05:32:10Z |
| publishDate | 2019-07-01 |
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| series | BMC Pulmonary Medicine |
| spelling | doaj.art-ffbbd8fd6ccc480bbbe2e156787095512022-12-21T23:58:02ZengBMCBMC Pulmonary Medicine1471-24662019-07-011911710.1186/s12890-019-0872-0The 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 studyMayanka Tickoo0Robin Ruthazer1Amit Bardia2Shira Doron3Gabriela M. Andujar-Vazquez4Bradley J. Gardiner5David R. Snydman6Sebastian G. Kurz7Department of Internal Medicine, Division of Pulmonary, Sleep and Critical Care, Yale School of MedicineBiostatistics, Epidemiology, Research, and Design Center, Tufts Clinical and Translational Science Institute, Tufts University School of MedicineDepartment of Anesthesiology, Yale School of MedicineDivision of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of MedicineDivision of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of MedicineDivision of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of MedicineDivision of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of MedicinePulmonary and Critical Care Division, Mount Sinai National Jewish Respiratory InstituteAbstract 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.http://link.springer.com/article/10.1186/s12890-019-0872-0COPDViral assay panelAntibiotic prescription |
| spellingShingle | Mayanka Tickoo Robin Ruthazer Amit Bardia Shira Doron Gabriela M. Andujar-Vazquez Bradley J. Gardiner David R. Snydman Sebastian G. Kurz 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 BMC Pulmonary Medicine COPD Viral assay panel Antibiotic prescription |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | COPD Viral assay panel Antibiotic prescription |
| url | http://link.springer.com/article/10.1186/s12890-019-0872-0 |
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