Effect of the Influenza Virus Rapid Antigen Test on a Physician's Decision to Prescribe Antibiotics and on Patient Length of Stay in the Emergency Department

Abstract

BackgroundInfluenza virus infection is a common reason for visits to the emergency department (ED) during the influenza season. A rapid and accurate diagnosis of influenza virus infection is important to reduce unnecessary antibiotic prescription and to improve patient care. The aim of this study was to examine whether using the Influenza Virus Rapid Antigen Test (IVRAT) in the ED affects the decision to prescribe antibiotics or the length of hospital stay (LOS).MethodsData from patients suffering from an influenza-like illness (ILI) and who were discharged after visiting the ED at Chungbuk National University Hospital were reviewed over two influenza seasons: 2010–2011, when IVRAT was not used in the ED, and 2011–2012, when it was. The numbers of antibiotic prescriptions issued and the ED LOS during these two seasons were then compared.ResultsThe number of antibiotic prescriptions was significantly lower in 2011–2012 (54/216, 25.0%) than in 2010–2011 (97/221, 43.9%; P<0.01). However, the median ED LOS for patients in 2011–2012 was much longer than that of patients in 2010–2011 (213 minutes vs. 257 minutes; P<0.01). During the 2011–2012 influenza season, 73 ILI patients showed a positive IVRAT result whereas 123 showed a negative result. Upon discharge, antibiotics were given to 42/123 (34.1%) ILI patients with a negative IVRAT result, but to only 7/73 (9.6%) patients with a positive IVRAT result (P<0.01).ConclusionsPerforming IVRAT in the ED reduced the prescription of antibiotics to ILI patients discharged after ED care. However, the ED LOS for patients who underwent IVRAT was longer than that for patients who did not. Thus, performing IVRAT in the ED reduces the unnecessary prescription of antibiotics to ILI patients during the influenza season.

Influence of time to diagnosis of severe influenza on antibiotic use, length of stay, isolation precautions, and mortality: a retrospective study

“…Second, our observations are only applicable to hospitalized adults with severe influenza; they cannot be extrapolated to adult outpatients with mild influenza or children. Early diagnosis might help optimize treatment and influence antibiotic selection pressure in these populations, as shown by others . Last, the interpretation of our findings is limited by the retrospective design of the study.…”

“…We hypothesized that early diagnosis would reduce antibiotic use and antibiotic treatment duration in hospitalized patients with influenza diagnosis, as viral respiratory infections normally do not require antibiotic therapy. This hypothesis was supported by Jeong et al., who showed a reduction of antibiotic prescriptions in outpatients with flu‐like symptoms after introduction of an influenza virus rapid antigen test in the emergency department . Furthermore, Rogers et al.…”

“…Early diagnosis might help optimize treatment and influence antibiotic selection pressure in these populations, as shown by others. [20][21][22][23][24][25]38 Last, the interpretation of our findings is limited by the retrospective design of the study. Our results should be confirmed in the setting of a prospective study to eliminate bias.…”

“…As antibiotic overuse is associated with emergence of antibiotic resistance, rapid influenza diagnosis may therefore reduce antibiotic selection pressure, resistance development, and support appropriate treatment. Consequently, rapid diagnosis of influenza has previously been shown to help reduce the use of antibiotics in adult outpatients and was shown to reduce the duration of antibiotic therapy, the amount of prescription, and the length of hospital stay in children . Recent studies suggested a general benefit of hospitalized patients from early influenza diagnosis by reducing the need for extended care after hospital discharge in older adults, mortality, and the risk of lower respiratory tract complications .…”

Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

“…Our systematic review highlights the potential of POCTs for influenza in reducing ED LOS; however, results were mixed, and two studies actually reported that POCT led to an increased LOS in ED. Jeong et al attributed longer ED stay to the significantly older age of their POCT cohort that may have had more comorbidities, whilst reasons for the other study are unclear . Emergency department LOS can be influenced by many factors including availability of beds, overcrowding, admission and discharge procedures, and the efficiency of ED staff.…”