No impact of early real-time PCR screening for respiratory viruses on length of stay and use of antibiotics in elderly patients hospitalized with symptoms of a respiratory tract infection in a single center in Norway
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We tested the hypothesis that the results of real-time polymerase chain reaction (PCR) analyses for respiratory viruses would reduce antibiotic treatment and length of stay in elderly patients hospitalized with respiratory infections. Within 24 h of hospital admission, a total of 922 patients aged ≥60 years were interviewed for symptoms of ongoing respiratory tract infection. Symptomatic patients were swabbed for oropharyngeal/nasopharyngeal presence of viral pathogens immediately by members of the study group. During a 2-month period, non-symptomatic volunteers among interviewed patients were swabbed as well (controls). Oropharyngeal/nasopharyngeal swabs were analyzed with real-time PCR for nine common respiratory viruses. A total of 147 out of 173 symptomatic patients and 56 non-symptomatic patients (controls) agreed to participate in the study. The patients were allocated to three cohorts: (1) symptomatic and PCR-positive (S/PCR+), (2) symptomatic and PCR-negative (S/PCR−), or (3) non-symptomatic and PCR-negative (control). There were no non-symptomatic patients with a positive PCR result. A non-significant difference in the frequency of empiric antibiotic administration was found when comparing the S/PCR+ to the S/PCR− cohort; 16/19 (84 %) vs. 99/128 (77 %) (χ2 = 0.49). Antibiotic treatment was withdrawn in only two patients in the S/PCR+ cohort after receiving a positive viral diagnosis. The length of stay did not significantly differ between the S/PCR+ and the S/PCR− groups. We conclude that, at least in our general hospital setting, access to early viral diagnosis by real-time PCR had little impact on the antimicrobial treatment or length of hospitalization of elderly patients.
KeywordsRespiratory Syncytial Virus Respiratory Virus Polymerase Chain Reaction Result Positive Polymerase Chain Reaction Charlson Comorbidity Index Score
Thanks go to Anne Liv Lyngroth for her contribution to the study planning and data acquisition.
Conflict of interest
The nylon flocked swabs and UTM transport tubes were donated by Copan Italia, Bresica, Italy, and the rayon swabs and transport medium were donated by Chemi-teknik A/S, Oslo, Norway. Both suppliers delivered the swabs free of charge. The suppliers had no role in the planning, running, evaluation, or reporting of this trial. The authors declare that they have no conflict of interest related to this report.
This project was financed with the aid of EXTRA funds from the Norwegian Foundation for Health and Rehabilitation in association with the Norwegian Heart and Lung Patient Organization, from the South-Eastern Norway Regional Health Authority, and from Sorlandet Hospital HF.
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