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21% of patients in three EDs got antibiotics despite viral diagnosis
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Researcher found that approximately one-fifth of patients diagnosed with a viral respiratory infection during a 6-month period in three California EDs were nevertheless prescribed antibiotics.
“Respiratory illness is a leading cause of ED visits nationwide, with a wide range of clinical presentations including pneumonia (one of the top causes of mortality in the United States). With the overwhelming burden of respiratory illness caused by viral pathogens, the American College of Physicians and the [CDC] provide evidence-based guidelines to encourage clinicians to avoid unnecessary antibiotic usage for viral infections,” Lynn N. Fitzgibbons, MD, an infectious disease physician in the Santa Barbara Cottage Hospital department of medical education, and colleagues wrote.
“However, antibiotic prescribing rates remain inappropriately high, especially in outpatient settings, and this is linked to increased risk of resistant bacterial infections, adverse effects, and the development of [Clostridioides] difficile infection.”
Fitzgibbons and colleagues conducted a retrospective, observational analysis of patients with PCR-diagnosed viral respiratory infections (VRIs) in three EDs within one health system to identify patients who were prescribed antibiotics and characteristics that influenced unnecessary prescribing. Patients with a PCR result time-stamped after their discharge were not included because Fitzgibbons and colleagues “felt that the provider did not have the diagnosis of a viral illness prior to determining the need for antibiotics.”
In total, 323 patients were discharged from the ED with a VRI diagnosis between October 2016 and March 2017, with 68 (21.1%) having been prescribed antibiotics. According to the study, patients who received inappropriate antibiotics were older, experienced symptoms longer, were more likely to have received antibiotics in the preceding 7 days and had higher proportions of abnormal chest X-rays, Fitzgibbons and colleagues reported.
Additionally, the researchers determined that patients were more likely to be prescribed antibiotics for a diagnosis of pneumonia or otitis media and were less likely to receive them for a diagnosis of upper respiratory infection or influenza.
“This study contributes to the small but growing body of literature in the outpatient setting aiming to illuminate PCR utilization with respect to antibiotic prescribing behaviors,” the authors concluded.
“Opportunities exist for partnered antimicrobial and diagnostic test stewardship strategies. It is vital that lessons are learned, and that information is disseminated efficiently and effectively around optimizing diagnostic test utilization, patient education regarding viral illnesses and treatments, and provider support surrounding clinical decision-making in the era of rapid molecular test. Ideally, this will promote judicious diagnostic testing such as PCR, with ultimate goals of improving patient outcomes and cost-effective care.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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