Impact of multiplex respiratory virus testing on antimicrobial consumption in adults in acute care: a randomized clinical trial.
OBJECTIVES
Inappropriate use of antibiotics is associated with development of antimicrobial resistance. In respiratory infections it is often difficult to differentiate between viral and bacterial infections, and empirical treatment is common. Enhanced viral testing is expected to clarify clinical decision-making and reduce the prescription of antibacterial agents, but the impact of such information on patient care is unclear.


METHODS
We conducted a (1:1) randomized controlled clinical trial involving 998 adults with respiratory symptoms, fever, chest pain or poor general condition in the emergency unit of a tertiary hospital. Multiplex PCR results for 496 patients were available in 24 hours (intervention group) and those for the remaining 502 patients were available in 7 days (control group). Our primary outcome measures were the duration of hospitalization and the consumption of antibiotics within 30 days of enrolment.


RESULTS
In all, 841 of 998 (84%) patients had respiratory symptoms at study entry. A respiratory virus was detected in 175 (17.5%). The mean duration of hospitalization was 4.2 days (SD 5.4) in the intervention group and 4.1 days (SD 4.9) in the control group (difference 0.1, 95% CI -0.5 to 0.6, p 0.810). The mean days on antibiotics were 11.3 days (SD 12.6) in the intervention group and 10.4 days (SD 11.4) in the control group (difference 0.9, 95% CI -0.6 to 2.4, p 0.235).


CONCLUSIONS
Multiplex PCR testing for respiratory viruses with results available within 24 hours did not reduce the consumption of bacterial antibiotics or the length of hospital stay in adults presenting with respiratory symptoms, fever, chest pain or reduced general condition in acute care.
['Saarela|E|E|', 'Tapiainen|T|T|', 'Kauppila|J|J|', 'Pokka|T|T|', 'Uhari|M|M|', 'Kauma|H|H|', 'Renko|M|M|']
D000328:Adult D000368:Aged D000900:Anti-Bacterial Agents D001424:Bacterial Infections D024901:Drug Resistance, Multiple, Bacterial D004363:Drug Utilization D005260:Female D006760:Hospitalization D006801:Humans D057970:Inappropriate Prescribing D008297:Male D008875:Middle Aged D060885:Multiplex Polymerase Chain Reaction D012141:Respiratory Tract Infections D062606:Tertiary Care Centers D014777:Virus Diseases D014780:Viruses
Respiratory virus Randomized Multiplex PCR Antibiotic stewardship Cost analysis