More targeted use of oseltamivir and in-hospital isolation facilities after implementation of a multifaceted strategy including a rapid molecular diagnostic panel for respiratory viruses in immunocompromised adult patients

J Clin Virol. 2019 Jul:116:11-17. doi: 10.1016/j.jcv.2019.04.003. Epub 2019 Apr 7.

Abstract

Background: Immunocompromised adults are more vulnerable to a complicated course of viral respiratory tract infections (RTI).

Objectives: Provide evidence on the effect of implementation of rapid molecular diagnostics for viruses on use of in-hospital isolation facilities, oseltamivir and antibiotic usage, and other clinical outcomes in immunocompromised patients.

Study design: A before-after study during two consecutive respiratory viral seasons, including immunocompromised adult patients presenting at a tertiary care emergency department with clinical suspicion of RTI. During the first season (2016/2017), respiratory viruses were detected using inhouse real-time PCR. The second season (2017/2018), we implemented a diagnostic flowchart including a rapid molecular test for 15 respiratory viruses (FilmArray®). We assessed the effect of this implementation on need for isolation, antivirals and empirical antibiotics.

Results: We included 192 immunocompromised adult patients during the first and 378 during the second season. Respiratory viral testing was performed in 135 patients (70%) during the first and 284 (75%) during the second season (p = 0.218) of which 213 (75%) using the rapid test. After implementation, use of in-hospital isolation facilities was reduced (adjusted odds ratio 0.35, 95%CI 0.19-0.64). Furthermore, adequate use of oseltamivir improved, with fewer prescriptions in influenza negative patients (0.15, 95%CI 0.08-0.28) and more in influenza positive patients (11.13, 95%CI 1.75-70.86). No effect was observed on empirical antibiotic use, hospital admissions, length of hospital stay or safety outcomes.

Conclusions: Implementation of rapid molecular testing for respiratory viruses in adult immunocompromised patients results in more adequate use of oseltamivir and in-hospital isolation facilities without compromising safety.

Keywords: Clinical impact; Immunocompromised; Rapid molecular diagnostics; Respiratory viruses.

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Immunocompromised Host*
  • Influenza, Human / diagnosis
  • Influenza, Human / immunology
  • Influenza, Human / therapy
  • Male
  • Middle Aged
  • Molecular Diagnostic Techniques
  • Oseltamivir / therapeutic use*
  • Patient Isolation / statistics & numerical data*
  • Reagent Kits, Diagnostic
  • Respiratory Tract Infections / diagnosis*
  • Respiratory Tract Infections / immunology
  • Respiratory Tract Infections / therapy*
  • Viruses / drug effects
  • Viruses / genetics
  • Viruses / isolation & purification*

Substances

  • Antiviral Agents
  • Reagent Kits, Diagnostic
  • Oseltamivir