Australian study links rapid flu tests to reduction in antibiotic prescribing

Antibiotics were initiated less frequently, and antivirals used more frequently, in patients diagnosed as having influenza using rapid polymerase chain reaction (RPCR) tests compared with standard multiplex PCR (MPCR) tests, Australian researchers reported yesterday in BMC Infectious Diseases.

In the retrospective cohort study, the researchers compared outcomes in patients with positive influenza RPCR and MPCR tests at Prince of Wales Hospital in Sydney during the 2017 flu season, examining test turnaround times, antibiotic initiation, oseltamivir initiation, and hospital length of stay (LOS) for both emergency department and inpatient hospital stay.

The RPCR test introduced by the New South Wales public health system in 2017 returns results within 4 hours, while standard MPCR test results are available from 1 to 4 days. Previous research has suggested the potential for reduced antibiotic therapy and increased antiviral use with RPCR tests, but the data are limited.

Of the 484 positive test results identified by the researchers, 362 were from standard MPCR tests and 122 were from RPCR tests. The median turnaround time for the RPCR tests was 2.6 hours, compared with 22.6 hours for the MPCR tests.

Commencement of antibiotics was less frequent in the RPCR than the MPCR cohorts (51% vs 67%; odds ratio [OR], 0.52; 95% confidence interval [CI], 0.34 to 0.79). Patients at high risk of complications from influenza who were tested with RPCR tests were more likely to be treated with oseltamivir than those tested with MPCR tests (76% vs 63%; OR, 1.81; 95% CI, 1.07 to 3.08). No significant difference between the two groups was observed for hospital or emergency department LOS.

“Taken together these data show a very positive impact on appropriate antimicrobial prescribing following introduction of a RPCR influenza test at our institution,” the authors wrote.
Apr 7 BMC Infect Dis study

Latin American ICUs show benefit from comprehensive stewardship

A study involving 77 Latin American hospitals found that medical-surgical intensive care units (MS-ICUs) with more comprehensive antimicrobial stewardship programs (ASPs) used fewer antibiotics and had fewer multidrug-resistant infections, researchers reported today in Infection Control & Hospital Epidemiology.

The study, conducted over 2 years, included a network of hospitals from nine Latin American countries. During the 6-month preintervention period, ASP members at each hospital were trained through an online course. In the following 12 months, the hospitals implemented locally salient antimicrobial stewardship strategies, and monthly point-prevalence surveys were conducted to measure the appropriateness of antimicrobial prescribing, antimicrobial consumption, mortality, and incidence of multidrug-resistant organisms in healthcare-associated infections (MDRO-HAIs). Self-assessment surveys of the ASPs (using a 0 to 100 scale) were conducted at the beginning and end of the study.

The hospitals were stratified into three groups according to the global score of the final self-assessment (ie, the 25th percentile or lower, between the 25th and 75th percentile, and the 75th percentile or higher). Overall 76.6% of the ASPs showed significant improvement in their self-assessment scores, but only 26% reached the 75th percentile or higher in the final self-assessment, and 23.4% did not improve their scores.  

The point-prevalence surveys showed that the MS-ICUs in the 75th versus 25th percentiles performed better on several indicators: antimicrobial consumption (143.4 vs 159.4 defined daily doses per 100 patient-days), adherence to clinical guidelines (92.5% vs 59.3%), validation of prescriptions by pharmacists (72.0% vs 58.0%), crude mortality (15.9% vs 17.7%), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient-days). Only Clostridioides difficile infection rates were higher in the MS-ICUs above the 75th percentile.

“Our findings confirm that ASPs are often only partially implemented in Latin American hospitals,” the study authors wrote. “This issue represents a very important challenge because institutional support, interventions to optimizing antibiotic use, monitoring and reporting processes, as well as physician education, are necessary to implement an ASP effectively.”
Apr 8 Infect Control Hosp Epidemiol study