Clinical impact of rapid diagnostics using Xpert Flu/RSV PCR on antimicrobial stewardship initiatives during influenza season

Abstract

BACKGROUND: Despite the availability of several rapid Influenza tests (RIT), the literature on its impact on antimicrobial stewardship programs (AMS) is minimal. Studies utilising rapid point of care tests (POCT) have shown benefit in terms of shortening antimicrobial therapy and prescriptions of antivirals. We designed this study to assess whether RIT had an impact on antibiotic cessation. METHODS: Xpert Flu/RSV (Cepheid, CA) was performed on all patients who presented with influenza-like illness (ILI) in 2017. Clinical data was collected from electronic medical records (eMR). Patients with RSV were not included. Turnaround time (TAT) for the test was time from specimen collection until when the result was either notified or appeared on eMR. Standard univariate analysis and multivariable regression analysis (MVRA) were done. RESULTS: A total of 665 patients tested positive-Influenza A (63%) and B (37%). After positive results, antimicrobials were ceased in 34% (226/665) or not given in 10% (71/665) cases. Median TAT was 7 h, with 50% of tests completed in less than 6 h 56% (368/665) of patients had their antibiotics continued. On MVRA, results of RIT within 6-12 h resulted in most antibiotic cessation (73%, OR 1.55, p = 0.01). It was found that antibiotics are continued in immunosuppressed patients (OR 2.88, p < 0.01), patients with pneumonia (OR 18.8, p < 0.01) and with underlying COPD (OR 2.43, p = 0.03). CONCLUSION: Influenza patients are more likely to have their antibiotics continued with underlying COPD, pneumonia, or immunosuppression. Results of RIT within 6-12 h can help clinicians in deciding on cessation of antibiotics in patients.