95. Assess reasons for continuing antibiotics in persons with positive respiratory viruses PCR in the emergency room
Bibliographic record
Abstract
Abstract Background Respiratory tract infections remain one of the major reasons for inappropriate antibiotic usage. The multiplex PCR respiratory viral panel improves the diagnostic ability of viral causes of RTI and have been advocated as a useful stewardship tool. We sought to evaluate factors leading to continued antibiotic following a positive respiratory viral PCR and to evaluate the impact of a targeted antimicrobial stewardship intervention on antibiotic use. Methods In this Quasi experimental study, adult patients presenting to RVH ER with positive respiratory PCR from January 13 2020 to February 27 2020 were reviewed. Patient demographics, clinical, comorbidities, laboratory and radiology reports, antibiotic and antiviral usage before and after test were recorded. For patients without microbiological or radiological evidence of bacterial infection, a standard questionnaire was administered to treating physician. Antibiotic prescribing rate before and following a positive PCR and antibiotic discontinuation following ASP questionnaire was tracked. Results During the study period, 147 adult patients presented to the ER with positive respiratory PCR were. Among the study population, antibiotic prescription rate was 49% prior to test result. Influenza was the most common respiratory virus isolated(89/147). Following the respiratory viral PCR, antibiotics were stopped 39% and continued in 51 % by the treating physician. Main reasons for antibiotic continuation included concurrent bacterial infection16/30 (pneumonia 9/30), COPD exacerbation 5/30, febrile neutropenia (5/30) and hemodynamic instability(4/30). Antibiotics were continued without obvious indications in 15 patients and were targeted for intervention. Overall 66% (10/15) of ASP interventions were accepted and antibiotics discontinued. Overall antibiotics were discontinued in 53 % of patients in whom they were initiated pretest result. Conclusion This study shows that positive respiratory virus PCR is very useful as it led to discontinuation of antibiotics by treating physician in 40 % and further 13% by an antibiotic stewardship intervention. Adding a stewardship intervention after test result further adds reduction to antibiotic usage. 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 | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".