Targeted Antimicrobial Stewardship Intervention for Inpatients With Viral respiratory tract infections
Bibliographic record
Abstract
Background. Patients admitted with respiratory tract infections receive empiric coverage for community acquired pneumonia (CAP), despite an underlying viral etiology in many cases. Rapid and sensitive molecular testing for respiratory viruses is increasingly utilized but the impact of rapid diagnostics to optimize management remains unclear. Methods. Patients admitted to 2 acute care hospitals in Vancouver, Canada with a positive respiratory virus PCR between 1 December 2015 and 30 April 2016 were reported to the antimicrobial stewardship program (ASP) for direct audit and feedback interventions. Patients were excluded if they had other positive bacterial cultures or new lobar consolidation/pneumonia reported on chest imaging. We assessed the total duration of antimicrobial therapy after a viral diagnosis and relevant patient outcomes (ICU admission and/or mechanical ventilation, represcription of antimicrobials within 14 days of diagnosis; and readmission, mortality and C. difficile within 30 days). Student's t-test and Fisher's exact test were utilized for analysis. Results. Overall 133 patients had a positive respiratory virus result, and 41 (31%) were excluded based on positive microbiologic or radiologic criteria. Of the 92 eligible patients, 24 patients (26%) were not receiving antimicrobials and results for remaining patients (68) included influenza A (32%), influenza B (26%), human metapneumovirus (18%), respiratory syncytial virus (12%), parainfluenza 1/2/3 (7%), dual infection (3%), and adenovirus (1%). Recommendations were accepted in 51 patients (75%): 34 (67%) discontinued antimicrobials, 15 (29%) were stepped down from intravenous to oral therapy, and 2 (4%) continued current therapy. Seventeen interventions (25%) were rejected. Total duration of antimicrobial therapy after viral diagnosis was 2.0 days (95% CI: 1.2–2.8) for accepted recommendations compared to 5.6 days (95% CI: 4.4–6.8) for rejected recommendations, p < 0.0001. There were no significant differences in other patient outcomes. Conclusion. For hospitalized patients with suspected CAP, integrating rapid molecular testing for respiratory viruses with an ASP intervention was safe and contributed to reduced antibiotic utilization. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".