Chest Infections |

Antimicrobial De-escalation Based on FilmArray Respiratory Panel and Serum Procalcitonin Testing FREE TO VIEW

Kenneth Sakata, MD; Natalya Azadeh, MD; Anjuli Brighton, MD; Christine Klassen, MD; Thomas Grys, PhD; Holenarasipur Vikram, MD
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Mayo Clinic Arizona, Scottsdale, AZ

Chest. 2015;148(4_MeetingAbstracts):112A. doi:10.1378/chest.2281727
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SESSION TITLE: Chest Infections Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Decisions regarding utilization of antibiotics (ABX) for respiratory tract infections (RTIs) are challenging given the difficulty in differentiating self-limiting viral from bacterial RTIs. The nasopharyngeal FilmArray® Respiratory Panel (NP FARP) is able to detect 17 viruses and 3 bacteria commonly implicated in RTIs. Procalcitonin (PCT) has been shown to be elevated in RTIs caused by bacterial infections. This retrospective observational study sought to determine if the NP FARP and PCT assay can be used to guide ABX therapy decisions.

METHODS: We reviewed the records of all non-critically ill inpatients that had a NP FARP performed with or without a serum PCT between June 2013-June 2014. Patients with a PCT >0.25 µg/L were excluded. The following data was collected: demographic information; NP FARP results; PCT results if performed 48 hours of the NP FARP; ABX prior to and 48 hours after the NP FARP and PCT was resulted; immunosuppression (IS); Methicillin-resistant Staphylococcus aureus nasal swab (MRSA NS), and the reasons for ongoing ABX therapy. Patients were categorized into 2 groups. Patients who had a deescalation or discontinuation of ABX or never received ABX (DDN) were in one group. Those who continued on the same ABX regimen or had an escalation in therapy (CE) comprised of the second group. Clinical outcome data was not recorded.

RESULTS: 545 patients were included in the study analysis. The median age and proportions of IS patients between both DDN and CE groups were identical. In patients who had a positive NP FARP, the proportions of DDN and CE ABX decisions were 59% and 41%, respectively. Among patients who had a negative NP FARP, the proportions of DDN and CE were 58% vs. 42%, respectively. While the sample size is small, there were a greater proportion of patients who had DDN decisions with a negative PCT, as opposed to those who did not have a PCT done. In the deescalation group alone, there were 102 patients who had their anti-MRSA ABX discontinued. Of these, 67 (66%) patients had a concurrent negative MRSA NS and 31 (30%) did not have an MRSA NS performed.

CONCLUSIONS: In non-critically ill patients with RTIs, the NP FARP alone does not appear to correlate with DDN antibiotic decisions. A combined approach utilizing NP FARP plus PCT and/or MRSA NS may facilitate deescalation or discontinuation of empiric broad spectrum antibiotic therapy.

CLINICAL IMPLICATIONS: Antibiotic stewardship practices in RTIs can be enhanced if the NP FARP is combined with PCT and/or MRSA NS.

DISCLOSURE: The following authors have nothing to disclose: Kenneth Sakata, Natalya Azadeh, Anjuli Brighton, Christine Klassen, Thomas Grys, Holenarasipur Vikram

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