The rapid diagnosis of viral respiratory tract infections and its impact on antimicrobial stewardship programs

  • Şiran Keske
  • Önder Ergönül
  • Faik Tutucu
  • Doruk Karaaslan
  • Erhan Palaoğlu
  • Füsun Can
Original Article


We aimed to describe the potential benefit of new rapid molecular respiratory tests (MRT) in decreasing inappropriate antibiotic use among the inpatients presenting with influenza-like illness (ILI). We included patients from inpatient and outpatient departments who had ILI and performed MRT between 1 January 2015 and 31 December 2016 in a 265-bed private hospital in Istanbul. At the end of 2015, we implemented antimicrobial stewardship including systematic use of MRT. Then, we compared our observations between the year 2015 and the year 2016. We designed the study according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) tool. A U.S. Food and Drug Administration (FDA)-cleared multiplexed polymerase chain reaction (PCR) system (BioFire FilmArray, Idaho Technology, Salt Lake City, UT) which detects 17 viruses and three bacteria was used for diagnosis. In total, 1317 patients were included; 630 (48%) were inpatients and 569 (43%) were older than 16 years of age. At least one virus was detected in 747 (57%) patients. Rhinovirus/enterovirus, influenza virus, and adenovirus were the most commonly detected. Among hospitalized patients, in children, a significant decrease in antibiotic use (44.5% in 2015 and 28.8% in 2016, p = 0.009) was observed, but in adults, the decrease was not statistically significant (72% in 2015 and 63% in 2016, p = 0.36). The duration of antibiotic use after the detection of virus was significantly decreased in both children and adults (p < 0.001 and p = 0.007, respectively). By using MRT, inappropriate antibiotic use and, also, duration of inappropriate antibiotic use after the detection of virus was significantly decreased. It is time to increase the awareness about the viral etiology in respiratory tract infections (RTIs) and implement MRT in clinical practice.



No funding of any kind has been received. The data were generated as part of routine work.

Compliance with ethical standards

Conflict of interest

None to declare.

Ethical approval

Koç University IRB approved the study.

Informed consent

Not applicable.


  1. 1.
    Widmer K, Zhu Y, Williams JV, Griffin MR, Edwards KM, Talbot HK (2012) Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis 206(1):56–62CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Hirsch HH, Martino R, Ward KN, Boeckh M, Einsele H, Ljungman P (2013) Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus. Clin Infect Dis 56(2):258–266CrossRefPubMedGoogle Scholar
  3. 3.
    Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, Reed C, Grijalva CG, Anderson EJ, Courtney DM, Chappell JD, Qi C, Hart EM, Carroll F, Trabue C, Donnelly HK, Williams DJ, Zhu Y, Arnold SR, Ampofo K, Waterer GW, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, McCullers JA, Pavia AT, Edwards KM, Finelli L; CDC EPIC Study Team (2015) Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 373(5):415–427CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Schanzer DL, Langley JM, Tam TW (2008) Role of influenza and other respiratory viruses in admissions of adults to Canadian hospitals. Influenza Other Respir Viruses 2(1):1–8CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ebell MH, Radke T (2015) Antibiotic use for viral acute respiratory tract infections remains common. Am J Manag Care 21(10):e567–e575PubMedGoogle Scholar
  6. 6.
    Mainous AG 3rd, Saxena S, Hueston WJ, Everett CJ, Majeed A (2006) Ambulatory antibiotic prescribing for acute bronchitis and cough and hospital admissions for respiratory infections: time trends analysis. J R Soc Med 99(7):358–362CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Grijalva CG, Nuorti JP, Griffin MR (2009) Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 302(7):758–766CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM Jr, Finkelstein JA, Gerber JS, Hyun DY, Linder JA, Lynfield R, Margolis DJ, May LS, Merenstein D, Metlay JP, Newland JG, Piccirillo JF, Roberts RM, Sanchez GV, Suda KJ, Thomas A, Woo TM, Zetts RM, Hicks LA (2016) Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 315(17):1864–1873CrossRefPubMedGoogle Scholar
  9. 9.
    Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK (2016) Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 62(10):e51–e77CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457CrossRefGoogle Scholar
  11. 11.
    World Health Organization (WHO) (2014) WHO surveillance case definitions for ILI and SARI. Case definitions for influenza surveillance. Available online at:
  12. 12.
    Goktas S, Sirin MC (2016) Prevalence and seasonal distribution of respiratory viruses during the 2014–2015 season in Istanbul. Jundishapur J Microbiol 9(9):e39132CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Yee C, Suarthana E, Dendukuri N, Nicolau I, Semret M, Frenette C (2016) Evaluating the impact of the multiplex respiratory virus panel polymerase chain reaction test on the clinical management of suspected respiratory viral infections in adult patients in a hospital setting. Am J Infect Control 44(11):1396–1398CrossRefPubMedGoogle Scholar
  14. 14.
    Afzal Z, Minard CG, Stager CE, Yu VL, Musher DM (2016) Clinical diagnosis, viral PCR, and antibiotic utilization in community-acquired pneumonia. Am J Ther 23(3):e766–e772CrossRefPubMedGoogle Scholar
  15. 15.
    Timbrook T, Maxam M, Bosso J (2015) Antibiotic discontinuation rates associated with positive respiratory viral panel and low procalcitonin results in proven or suspected respiratory infections. Infect Dis Ther 4(3):297–306CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gelfer G, Leggett J, Myers J, Wang L, Gilbert DN (2015) The clinical impact of the detection of potential etiologic pathogens of community-acquired pneumonia. Diagn Microbiol Infect Dis 83(4):400–406CrossRefPubMedGoogle Scholar
  17. 17.
    Branche AR, Walsh EE, Vargas R, Hulbert B, Formica MA, Baran A, Peterson DR, Falsey AR (2015) Serum procalcitonin measurement and viral testing to guide antibiotic use for respiratory infections in hospitalized adults: a randomized controlled trial. J Infect Dis 212(11):1692–1700CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Brendish NJ, Malachira AK, Armstrong L, Houghton R, Aitken S, Nyimbili E, Ewings S, Lillie PJ, Clark TW (2017) Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial. Lancet Respir Med 5(5):401–411CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Şiran Keske
    • 1
  • Önder Ergönül
    • 1
    • 2
  • Faik Tutucu
    • 2
  • Doruk Karaaslan
    • 2
  • Erhan Palaoğlu
    • 3
  • Füsun Can
    • 4
  1. 1.Infectious Diseases and Clinical Microbiology DepartmentAmerican HospitalIstanbulTurkey
  2. 2.Infectious Diseases and Clinical Microbiology DepartmentKoç University, School of MedicineIstanbulTurkey
  3. 3.Central LaboratoryAmerican HospitalIstanbulTurkey
  4. 4.Clinical Microbiology DepartmentKoç University, School of MedicineIstanbulTurkey

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