Respiratory viral panel lowers antibiotic use duration in ventilated patients

Key takeaways:

• Adopting respiratory viral panel testing led to shorter antibiotic usage and a lower risk for C. difficile infection.
• These outcomes went down more in hospitals with higher vs. lower adoption rates.

Among ventilated ICU patients with suspected infection, the length of antibiotic use went down after respiratory viral panel testing was adopted, according to results published in Annals of the American Thoracic Society.

“These results suggest that [respiratory viral panel] testing is a valuable tool to guide antibiotic use in patients with suspected infection,” Jacqueline Dinh, MD, MS, pulmonary and critical care fellow at Boston Medical Center, and colleagues wrote.

Using 2016 to 2019 data from a claims-based database, Dinh and colleagues evaluated 31,644 adult ICU patients (mean age, 63 years; 53% women; 72% white) receiving invasive mechanical ventilation to see if respiratory viral panel (RVP) testing adoption has an impact on antibiotic duration. These patients were admitted to hospitals that did not use RVP in 2016, started using it in 2017 or 2018 and carried use of it over to 2019.

Researchers found changes in antibiotic duration by comparing outcomes 12 months before RVP use, at the time of RVP adoption and 12 months after adoption through an interrupted time series with multivariable hierarchical linear regression models.

Of the total cohort, 15,636 patients had an admission date before hospital RVP adoption, whereas the remaining 16,008 patients had an admission date after RVP adoption.

During the first month following RVP adoption, the number of antibiotic use days declined by 0.5 (95% CI, –0.8 to –0.1).

Researchers also observed a significant link between RVP testing adoption and a reduced risk for a Clostridioides difficile infection (–0.9%; 95% CI, –1.6% to –0.3%).

In terms of usage, researchers noted that RVP testing went up by 6.9% (95% CI, 6%-7.8%) 1 month following adoption.

Researchers continued to observe the above changes when assessed again at 12 months after adoption.

RVP adoption did not have a significant impact on hospitalization costs, length of stay or ventilator-associated pneumonia rates.

When divided by hospital RVP adoption rates (higher rate, n = 13,803; lower rate, n = 17,841), researchers observed larger reductions in several outcomes in the higher rate group, including antibiotic use, C. difficile infection, invasive mechanical ventilation and hospitalization costs.

“Future studies should explore if reductions in antibiotic-associated infections after RVP adoption are mediated by reductions in antibiotic duration or changes in antibiotic coverage,” Dinh and colleagues wrote.