scholarly journals Diagnostic Stewardship in Lower Respiratory Tract Infections Using Procalcitonin

2021 ◽  
Vol 1 (S1) ◽  
pp. s31-s32
Author(s):  
Amanda Gusovsky ◽  
David Burgess ◽  
Donna Burgess ◽  
Emily Slade ◽  
Chris Delcher ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Infectious Diseases ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Length Of Hospital Stay ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Background: A team of infectious diseases physicians, infectious diseases pharmacists, clinical laboratorians, and researchers collaborated to assess the management of lower respiratory tract infections (LRTIs). In 1 sample from our institution, 96.1% of pneumonia cases were prescribed antibiotics, compared to 85.0% in a comparison group. A collaborative effort led to the development of a protocol for procalcitonin (PCT)-guided antibiotic prescribing that was approved by several hospital committees, including the Antimicrobial Stewardship Committee and the Healthcare Pharmacy & Therapeutics Committee in December 2020. The aim of this analysis was to develop baseline information on PCT ordering and antibiotic prescribing patterns in LRTIs. Methods: We evaluated all adult inpatients (March–September 2019 and 2020) with a primary diagnosis of LRTI who received at least 1 antibiotic. Two cohorts were established to observe any potential differences in the 2 most recent years prior to adoption of the PCT protocol. Data (eg, demographics, specific diagnosis, length of stay, antimicrobial therapy and duration, PCT labs, etc) were obtained from the UK Center for Clinical and Translational Science, and the study was approved by the local IRB. The primary outcome of interest was antibiotic duration; secondary outcomes of interest were PCT orders, discharge antibiotic prescription, and inpatient length of stay. Results: In total, 432 patients (277 in 2019 and 155 in 2020) were included in this analysis. The average patient age was 61.2 years (SD, ±13.7); 47.7% were female; and 86.1% were white. Most patients were primarily diagnosed with pneumonia (58.8%), followed by COPD with complication (40.5%). In-hospital mortality was 3.5%. The minority of patients had any orders for PCT (29.2%); among them, most had only 1 PCT level measured (84.1%). The median length of hospital stay was 4 days (IQR, 2–6), and the median duration of antibiotic therapy was 4 days (IQR, 3–6). Conclusions: The utilization of PCT in LRTIs occurs in the minority of patient cases at our institution and mostly as a single measurement. The development and implementation of a PCT-guided therapy could help optimize antibiotic usage in patients with LRTIs.Funding: NoDisclosures: None

scholarly journals Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101015 ◽  
Author(s):  
Anna B Moberg ◽  
Olof Cronberg ◽  
Magnus Falk ◽  
Katarina Hedin
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Diagnostic Tests ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Acute Bronchitis ◽  
Antibiotic Prescribing ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections ◽  
Over Time

BackgroundDifferentiating between pneumonia and acute bronchitis is often difficult in primary care. There is no consensus regarding clinical decision rules for pneumonia, and guidelines differ between countries. Use of diagnostic tests and change of management over time is not known.AimTo calculate the proportion of diagnostic tests in the management of lower respiratory tract infections (LRTIs) in a low antibiotic prescribing country, and to evaluate if the use and prescription pattern has changed over time.Design & settingA register-based study on data from electronic health records from January 2006 to December 2014 in the Kronoberg county of south east Sweden.MethodData regarding use of C-reactive protein (CRP), chest x-rays (CXRs), microbiological tests, and antibiotic prescriptions were assessed for patients aged 18–79 years, with the diagnosis pneumonia, acute bronchitis, or cough.ResultsA total of 54 229 sickness episodes were analysed. Use of CRP increased during the study period from 61.3% to 77.5% for patients with pneumonia (P<0.001), and from 53.4% to 65.7% for patients with acute bronchitis (P<0.001). Use of CXR increased for patients with acute bronchitis from 3.1% to 5.1% (P<0.001). Use of microbiological tests increased for patients with pneumonia, from 1.8% to 5.1% (P<0.001). The antibiotic prescription rate decreased from 18.6 to 8.2 per 1000 inhabitants per year for patients with acute bronchitis, but did not change for patients with pneumonia.ConclusionUse of CRP and microbiological tests in the diagnostics of LRTIs increased despite the fact that the incidence of pneumonia and acute bronchitis was stable.

scholarly journals Educational differences in acute infectious diseases in the Netherlands: results from a nationwide health survey

2020 ◽  
Vol 30 (2) ◽  
pp. 270-275 ◽  
Author(s):  
Brechje de Gier ◽  
Marieke Houben - van Herten ◽  
Ellen Uiters ◽  
Susan J M Hahné
Keyword(s):  
The Netherlands ◽  
Infectious Diseases ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Lower Respiratory Tract Infections ◽  
Educational Differences ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background It is unclear to what extent socioeconomic inequalities exist in common infectious diseases in high-income countries. We aimed to explore educational differences in five common acute infectious diseases in adults in the Netherlands. Methods As part of a year-round repeated cross-sectional health survey, adults aged 25 and older were asked if they had experienced acute upper or lower respiratory tract infections, acute otitis media, urinary tract infections or gastro-enteritis in the two previous months. If so, participants were asked whether they had consulted their general practitioner and if they had been unable to perform their normal daily activities. These outcomes were analyzed per highest attained level of education. Results Data of 18 629 survey respondents were used in the analyses. People with a low educational level had lower odds of upper respiratory tract infections (OR 0.88, 95% CI 0.81–0.95), but higher odds of lower respiratory tract infections (OR 1.57, 95% CI 1.16–2.11). After adjustment for several covariates, the differences in upper respiratory tract infections remained statistically significant (aOR 0.84, 95% CI 0.77–0.91). The educational differences in lower respiratory tract infections were mitigated by adjusting for chronic diseases and health behaviours. For all infectious diseases, the likelihood of general practitioner consultation was highest for the lower educated group. Inability to work or perform normal daily activities due to an infectious disease was similar across all levels of education. Conclusion This study shows that educational differences in incidence and care seeking behaviours exist for common acute infectious diseases in the Netherlands.

scholarly journals Danish GPs’ Experiences When Managing Patients Presenting to General Practice with Symptoms of Acute Lower Respiratory Tract Infections: A Qualitative Study

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 661
Author(s):  
Lise Bisgaard ◽  
Camilla Aakjær Andersen ◽  
Morten Sig Ager Jensen ◽  
Lars Bjerrum ◽  
Malene Plejdrup Hansen
Keyword(s):  
General Practice ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Lower Respiratory Tract Infections ◽  
Structured Interviews ◽  
Diagnostic Strategies ◽  
Diagnostic Uncertainty ◽  
Tract Infections

One of the most common indications for antibiotic prescribing in general practice is acute lower respiratory tract infections (LRTI). This study aimed to explore general practitioners’ (GPs’) considerations and experiences when managing patients with symptoms of an acute LRTI. Individual semi-structured interviews were conducted with seven GPs in the North Denmark Region from January to March 2020. Data were analysed by means of systematic text condensation. The analysis revealed four themes: (1) practicalities of assessing patients with LRTI, (2) assessment of the patient, (3) treatment decisions, and (4) patient expectations. The GPs described having developed individual diagnostic strategies and routines when managing patients with symptoms of an acute LRTI. However, a general assessment of the patient was essential to all the GPs and the diagnosis was seldom based on a single symptom or finding. Most GPs described having great faith in abnormal lung auscultation. The use of C-reactive protein testing served several purposes, such as deciding on the severity of the infection, prescribing antibiotics or not, and as a communicative tool. Diagnostic uncertainty is a driver of antibiotic use and clinical practice might benefit from the development of clinical prediction rules for diagnosing pneumonia.

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