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

Abstract

BackgroundTimely diagnosis of influenza infection in patients might help reduce antibiotic use during influenza seasons and, consequently, antibiotic selection pressure. In this retrospective cohort study, we aimed to evaluate whether time to influenza diagnosis in patients with severe influenza is associated with the duration of antibiotic therapy.MethodsWe retrospectively included all hospitalized patients >16 years who tested positive for influenza A or B by polymerase chain reaction during influenza seasons 2013/2014 or 2014/2015 at the University Hospital Zurich. The primary aim was to assess the association between timing of laboratory‐confirmed influenza diagnosis and duration of antibiotic therapy. Secondary outcomes were length of hospital stay, duration of isolation precautions, and mortality. Early diagnosis was defined as laboratory confirmation on the day of or the day after hospital admission or symptom onset.ResultsA total of 126 patients were included (median age 57 years). Timing of influenza diagnosis was not associated with the duration of antibiotic treatment, the duration of isolation precautions, or mortality. Early influenza was associated with reduced length of hospital stay (median 7 vs 9 days [P=.014]) in patients with community‐acquired influenza.ConclusionsAlthough the duration of antibiotic therapy and mortality were found unaffected by early influenza diagnosis, our data indicate that it is linked with a reduction in the length of hospitalization in patients with community‐acquired influenza. This highlights a need to also fully understand the effect of time to diagnosis of bacterial pathogens on antibiotic prescribing patterns in order to exploit the potential of early influenza diagnosis in patient care.

Laboratory Diagnosis of Respiratory Tract Infections in Children – the State of the Art

“…Despite a short turnaround time of 1–2 h, the clinical utility of these assays has been questioned since no statistically significant reduction in antibiotic prescription rates or mortality has been observed between patients who tested positive for a non-influenza virus and those who tested negative (48% vs. 49% respectively) ( Green et al, 2016 ). In some cases, a reduction in length of hospital stay (7 days vs. 9 days) and duration of isolation (75 h vs. 82 h) was observed ( Rogers et al, 2015 ; Akers et al, 2017 ). The primary concerns for the high-plex sample-to-answer assays are high cost per test, and the inability to order customized, targeted panels ( Ramanan et al, 2018 ).…”

“…The non-specific clinical presentation of respiratory infections poses a considerable challenge to the differential diagnosis of these pathogens. Early and accurate diagnosis of the causative pathogens in respiratory infections is essential to administer appropriate antiviral or antibacterial therapy, initiate effective infection control measures, and reduce the length of hospital stay ( Barenfanger et al, 2000 ; Byington et al, 2002 ; Akers et al, 2017 ). In the last decade, there has been a remarkable improvement in the diagnosis of respiratory pathogens with the availability of molecular and point-of-care (POC) testing.…”

Respiratory syncytial virus infection is an underestimated cause of viral pneumoniae in adults

“…In theory, detection of viral pathogens responsible for pneumonia should reduce administration of antimicrobial treatment. Coinciding data from previously published retrospective studies showed that increased viral testing only partially altered antimicrobial treatment 17,18 . Here, we demonstrate that reasoning for ab treatment depends on multiple factors such as an elevated CRP, clinical and radiological indication for pneumonia, as well as age of the patient rather than on the clinicians' knowledge about RSV/test result.…”

Testing for Respiratory Viruses in Adults With Severe Lower Respiratory Infection

“…Similarly, in a recent retrospective review of 126 hospitalized patients with both CAP and hospital-acquired PCR-confirmed influenza, 75% received antibiotics. 51 In addition, the diagnosis of influenza was not associated with a reduction in antibiotic duration. Falsey et al 52 did find that patients who had a positive rapid influenza test result were less likely to receive antibiotics (86% vs 99%; P = .002) and more likely to receive antiviral therapy (73% vs 8%; P < .001) than patients whose rapid test result was negative.…”