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The Use of Antimicrobial Agents after Diagnosis of Viral Respiratory Tract Infections in Hospitalized Adults: Antibiotics or Anxiolytics?

Published online by Cambridge University Press:  02 January 2015

Kevin T. Shiley ,
Ebbing Lautenbach  and
Ingi Lee
Kevin T. Shiley*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ingi Lee*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
3rd Floor, Silverstein Pavilion, Suite D, 3400 Spruce Street, Philadelphia, PA 19103 (shileyk@uphs.upenn.edu)
Hospital of the University of Pennsylvania, Division of Infectious Diseases, 3rd Floor, Silverstein Pavilion, Suite E, 3400 Spruce Street, Philadelphia, PA 19104 (ingi.lee@uphs.upenn.edu)
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Extract

Objective.

Because extensive antibiotic use by inpatients has been associated with the development of multidrug-resistant organisms, we aimed to determine which variables were associated with the use of antibiotics after viral respiratory tract infection diagnosis among adult patients admitted to the hospital with respiratory symptoms.

Methods.

A retrospective cohort study was conducted at 2 affiliated urban hospitals in Pennsylvania. We identified all adult patients admitted to the hospital during the period from November 1, 2005, through August 1, 2007, with a viral assay positive for influenza A or B, parainfluenza, adenovirus, or respiratory syncytial virus. Among these patients, we identified those who received antibiotics after the diagnosis of viral RTL Data on demographics; comorbidities; and physical examination, laboratory, and radiographic findings were ascertained to identify risk factors for antimicrobial use among these patients.

Results.

A total of 196 hospitalized patients with positive viral assay results were included; 125 of 131 patients administered antibiotics continued to receive them after viral RTI diagnosis. Among 52 patients with an abnormal chest radiograph, 46 continued antibiotic therapy. An abnormal chest radiograph was independently associated with continued antibiotic use (adjusted odds ratio, 4.28 [95% confidence interval, 1.71-10.77]; P = .002). However, the majority of patients (79 of 125 [63%]) who continued antibiotic therapy had normal chest imaging findings. Eight patients (6%) who continued antibiotic therapy and no patients who stopped developed C. difficile infection (95% CI, 1.5-00; p = .05), but there was no significant difference in length of stay or mortality.

Conclusions.

Antibiotics are commonly used to treat hospitalized patients with known acute viral RTIs. Continued use is strongly associated with abnormal radiograph findings at admission. However, the reasons for continuation of antibiotics in the treatment of the majority of patients with normal radiographs are unclear and may represent inappropriate use.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 11 , November 2010 , pp. 1177 - 1183
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Courcol, RJ, Pinkas, M, Martin, GR. A seven year survey of antibiotic susceptibility and its relationship with usage. J Antimicrob Chemother 1989;23(3):441–451.CrossRefGoogle ScholarPubMed
2.Loeffier, JM, Garbino, J, Lew, D, Harbarth, S, Rohner, P. Antibiotic consumption, bacterial resistance and their correlation in a Swiss university hospital and its adult intensive care units. Scand J Infect Dis 2003;35:843–850.CrossRefGoogle Scholar
3.Ayşe, E, Aylin, Ç, Hürrem, B, Mustafa, Aç, Matthew, HS, Önder, E. Evaluation of antibiotic use in a hospital with an antibiotic restriction policy. Int J Antimicrob Agents 2003;21(4):308–312.Google Scholar
4.Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163(8):972–978.Google Scholar
5.Grijalva, CG, Nuorti, JP, Griffin, MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. IAMA 2009;302(7) :758–766.CrossRefGoogle ScholarPubMed
6.Fan, J, Henrickson, KJ, Savatski, LL. Rapid simultaneous diagnosis of infections with respiratory syncytial viruses A and B, influenza viruses A and B, and human parainfluenza virus types 1, 2, and 3 by multiplex quantitative reverse transcription-polymerase chain reaction-enzyme hybridization assay (Hexaplex). Clin Infect Dis 1998;26(6):1397–1402.Google Scholar
7.Byington, CL, Castillo, H, Gerber, H, et al.The effect of rapid respiratory viral diagnostic testing on antibiotic use in a children's hospital. Arch Pediatr Adolesc Med 2002;156(12):1230–1234.Google Scholar
8.Sharma, V, Dowd, MD, Slaughter, AJ, Simon, SD. Effect of rapid diagnosis of influenza virus type A on the emergency department management of febrile infants and toddlers. Arch Pediatr Adolesc Med 2002;156(1):41–43.Google Scholar
9.Pianosi, P, Feldman, W, Robson, MG, McGillivray, D. Inappropriate use of antibiotics in croup at three types of hospital. CMAJ 1986;134(4):357–359.Google ScholarPubMed
10.Doan, Q, Enarson, P, Kissoon, N, Klassen Terry, P, Johnson, DW. Rapid viral diagnosis for acute febrile respiratory illness in children in the emergency department. Cochrane Database Syst Rev 2009(4):CD006452. http://www.mrw.interscience.wiley.com/Cochrane/clsysrev/articles/CD006452/frame.html. Published October 7, 2009. Accessed January 20, 2010.Google Scholar
11.Oosterheert, JJ, van Loon, AM, Schuurman, R, et al.Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis 2005;41(10):1438–1444.Google Scholar
12.Falsey, AR, Murata, Y, Walsh, EE. Impact of rapid diagnosis on management of adults hospitalized with influenza. Arch Intern Med 2007;167(4):354–360.Google ScholarPubMed
13.Rahal, JJ, Urban, C, Horn, D, et al.Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA 1998;280(14):1233–1237.Google Scholar
14.Muller, AA, Mauny, F, Bertin, M, et al.Relationship between spread of methicillin-resistant Staphylococcus aureus and antimicrobial use in a French university hospital. Clin Infect Dis 2003;36(8):971–978.Google Scholar
15.Polk, RE, Johnson, CK, McClish, D, Wenzel, RP, Edmond, MB. Predicting hospital rates of fluoroquinolone-resistant Pseudomonas aeruginosa from fluoroquinolone use in US hospitals and their surrounding communities. Clin Infect Dis 2004;39(4):497–503.CrossRefGoogle ScholarPubMed
16.Fine, MJ, Auble, TE, Yealy, DM, et al.A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336(4) :243–250.Google Scholar
17.Akaike, H. A new look at the statistical model identification. IEEE Trans Automat Contr 1974;19:716–723.Google Scholar
18.Mandeli, LA, Wunderink, RG, Anzueto, A, et al.Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(suppl 2):S27–S72.CrossRefGoogle Scholar
19.de Roux, A, Marcos, MA, Garcia, E, et al.Viral community-acquired pneumonia in nonimmunocompromised adulte. Chest 2004;125(4):1343–1351.CrossRefGoogle Scholar
20.Johnstone, I, Majumdar, SR, Fox, JD, Marrie, TJ. Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation. Chest 2008;134(6):1141–1148.Google Scholar
21.Jennings, LC, Anderson, TP, Beynon, KA, et al.Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 2008;63(1) :42–48.Google Scholar
22.Johansson, N, Kalin, M, Tivehung-Lindell, A, Giske, CG, Hedlund, J. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis 2010;50(2):202–209.CrossRefGoogle ScholarPubMed
23.Smith, PW, Bennett, G, Bradley, S, et al.SHEA/APIC guideline: infection prevention and control in the long-term care facility. Am J Infect Control 2008;36(7):504–535.Google Scholar
24.Jones, P, Bigham, R, Manning, P. Use of antibiotics in nonbacterial respiratory infections. JAMA 1953;153:262–264.Google Scholar
25.Carrat, F, Schwarzinger, M, Housset, B, Valieron, AJ. Antibiotic treatment for influenza does not affect resolution of illness, secondary visits or lost workdays. Eur J Epidemiol 2004;19(7):703–705.CrossRefGoogle ScholarPubMed
26.Little, P, Rumsby, K, Kelly, J, et al.Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. JAMA 2005;293(24):3029–3035.Google Scholar
27.McCullers, JA, Bartmess, KC. Role of neuraminidase in lethal synergism between influenza virus and Streptococcus pneumoniae. J Infect Dis 2003;187(6):1000–1009.CrossRefGoogle ScholarPubMed
28.Peltola, VT, Murti, KG, McCuUers, JA. Influenza virus neuraminidase contributes to secondary bacterial pneumonia. J Infect Dis 2005;192(2):249–257.Google Scholar
29.McCuUers, JA. Effect of antiviral treatment on the outcome of secondary bacterial pneumonia after influenza. J Infect Dis 2004;190(3):519–526.CrossRefGoogle Scholar
30.Kaiser, L, Wat, C, Mills, T, Mahoney, P, Ward, P, Hayden, F. Impact of osel-tamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med 2003;163(14):1667–1672.CrossRefGoogle Scholar
31.Monto, AS, Webster, A, Keene, O. Randomized, placebo-controlled studies of inhaled zanamivir in the treatment of influenza A and B: pooled efficacy analysis. J Antimicrob Chemother 1999;44(suppl B):23–29.Google Scholar
32.Treanor, JJ, Hayden, FG, Vrooman, PS, et al.Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. JAMA 2000;283(8):1016–1024.Google Scholar