Effect of Respiratory Viral Panel Adoption on Antibiotic Use in Ventilated Patients.

Rationale Rapid respiratory viral panel (RVP) testing has become widely used to aid in the diagnosis and treatment of acute respiratory failure. However, the impact of RVP on antibiotic stewardship in critically ill patients is unclear. Objective To assess if adoption of RVP testing at hospitals was associated with changes in antibiotic duration in ICU patients receiving invasive mechanical ventilation. Methods Using data from the Premier Inc. Database from 2016-2019, we used interrupted time series with multivariable hierarchical linear regression models to quantify trends outcomes for 31,644 patients in the 12 months before RVP adoption, the level-change in outcomes at the time of RVP adoption (estimand of interest), and changes in outcome trends in the 12 months following RVP adoption. Results Hospital adoption of RVP testing (n = 62,603) was associated with a decrease in days of antibiotics by 0.5 days (95% CI -0.8, -0.1) in the first month following adoption. There was also a significant decrease in risk of Clostridioides difficile infection by 0.9% (95% CI -1.6, -0.3). There were no significant changes in other outcomes including hospitalization costs, hospital length-of-stay, or rates of ventilator-associated pneumonia. Conclusions Hospital adoption of RVP testing was associated with modest reductions in both antibiotic duration and risk of Clostridioides difficile infection among ICU patients with acute respiratory failure and suspected infection.