Significance of the detection of influenza and other respiratory viruses for antibiotic stewardship: Lessons from the post-pandemic period

Abstract

Objective: The aim was to describe the factors associated with antibiotic use in upper respiratory tract infections (URTI) in the post-pandemic influenza period. Methods: All consecutive patients who attended the emergency and outpatient departments of a private 265-bed hospital in Istanbul, Turkey with symptoms of an influenza-like illness (ILI) between January and June 2011 were included. Results: Out of 1270 patients, 100 were tested for Streptococcus A infection and 16 (16%) were found to be positive; 36 patients were tested for respiratory syncytial virus and five were found to be positive. A rapid influenza test (chromatographic) was performed for 325 patients and 45% were found to be positive for influenza A or B. In total, 500 patients (40%) were prescribed antibiotics; these were fluoroquinolones (12%), macrolides (10%), amoxicillin-clavulanate (10%), cefuroxime (7%), and third-generation cephalosporins (3%). On multivariate analysis, antibiotic prescription was found to be decreased by the diagnosis of influenza, whereas antibiotic prescription increased with age >65 years, C-reactive protein (CRP) >20 mg/L, polymorphonuclear leukocytes >80%, the detection of rales on auscultation, the presence of cough, comorbidities, and having infiltrations on a X-ray. Conclusions: The diagnosis of influenza is important for the implementation of antimicrobial stewardship programs. Each institution should implement an algorithm for the diagnosis and management of upper respiratory tract infections. Biomarkers such as CRP and procalcitonin should be used more effectively.