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Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia

Published online by Cambridge University Press:  01 December 2020

Michael Klompas Open the ORCID record for Michael Klompas [Opens in a new window] ,
Peter B. Imrey ,
Pei-Chun Yu ,
Chanu Rhee ,
Abhishek Deshpande ,
Sarah Haessler ,
Marya D. Zilberberg  and
Michael B. Rothberg
Michael Klompas*
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Peter B. Imrey
Affiliation:
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
Pei-Chun Yu
Affiliation:
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
Chanu Rhee
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Abhishek Deshpande
Affiliation:
Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
Sarah Haessler
Affiliation:
Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
Marya D. Zilberberg
Affiliation:
EviMed Research Group, LLC, Goshen, Massachusetts
Michael B. Rothberg
Affiliation:
Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
*
Author for correspondence: Michael Klompas, E-mail: [email protected]
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Abstract

Objective:

Viruses are more common than bacteria in patients hospitalized with community-acquired pneumonia. Little is known, however, about the frequency of respiratory viral testing and its associations with antimicrobial utilization.

Design:

Retrospective cohort study.

Setting:

The study included 179 US hospitals.

Patients:

Adults admitted with pneumonia between July 2010 and June 2015.

Methods:

We assessed the frequency of respiratory virus testing and compared antimicrobial utilization, mortality, length of stay, and costs between tested versus untested patients, and between virus-positive versus virus-negative patients.

Results:

Among 166,273 patients with pneumonia on admission, 40,787 patients (24.5%) were tested for respiratory viruses, 94.8% were tested for influenza, and 20.7% were tested for other viruses. Viral assays were positive in 5,133 of 40,787 tested patients (12.6%), typically for influenza and rhinovirus. Tested patients were younger and had fewer comorbidities than untested patients, but patients with positive viral assays were older and had more comorbidities than those with negative assays. Blood cultures were positive for bacterial pathogens in 2.7% of patients with positive viral assays versus 5.3% of patients with negative viral tests (P < .001). Antibacterial courses were shorter for virus-positive versus -negative patients overall (mean 5.5 vs 6.4 days; P < .001) but varied by bacterial testing: 8.1 versus 8.0 days (P = .60) if bacterial tests were positive; 5.3 versus 6.1 days (P < .001) if bacterial tests were negative; and 3.3 versus 5.2 days (P < .001) if bacterial tests were not obtained (interaction P < .001).

Conclusions:

A minority of patients hospitalized with pneumonia were tested for respiratory viruses; only a fraction of potential viral pathogens were assayed; and patients with positive viral tests often received long antibacterial courses.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 7 , July 2021 , pp. 817 - 825
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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