Hospital Pharmacy - October 2017 - 642
642
Hospital Pharmacy 52(9)
Table 1. Baseline Characteristics.
Variable
Male
Age, median (IQR)
Comorbidities
Immunocompromised
Type 2 diabetes mellitus
Chronic kidney disease
Chronic pulmonary diseasea
WBC (K/µL)
T Max (°F)
Heart rate
Respiratory rate
SIRSb
Antibiotics given
Penicillins
Cephalosporins
Carbapenems
Aztreonam
Macrolides
Fluoroquinolones
Vancomycin
Other
RVP (n = 70)
Rapid RP (n = 70)
P value
31 (44.3%)
70 (54-81)
31 (44.3%)
74 (64-84)
NS
NS
25 (35.7%)
15 (21.4%)
13 (18.6%)
25 (35.7%)
10.3 ± 13.5
99.6 ± 1.7
92.9 ± 17.5
19.2 ± 2.6
33 (47.1%)
13 (18.6%)
24 (34.3%)
7 (12%)
26 (37.1%)
12 ± 9.4
99.2 ± 1.6
92.5 ± 17.6
18.6 ± 2
22 (31.4%)
.036
NS
NS
NS
.012
NS
NS
NS
.08 NS
18 (25.7%)
21 (30%)
4 (5.7%)
1 (1.4%)
17 (24.3%)
12 (17.1%)
21 (30%)
3 (4.3%)
17 (24.3%)
22 (31.4%)
5 (7.1%)
4 (5.7%)
12 (17.1%)
17 (24.3%)
21 (30%)
5 (7.1%)
Note. RVP = respiratory viral panel; rapid RP = rapid respiratory panel; WBC = white blood cells; T Max = maximum temperature; SIRS = systemic
inflammatory response syndrome.
a
Chronic pulmonary diseases include patients with chronic obstructive pulmonary disease, asthma, and/or bronchiectasis.
b
Each factor in SIRS was recorded within 24 hours of respiratory viral panel polymerase chain reaction result.
Table 2. Pathogens Detected Among Patients With a Positive
Respiratory Viral Panel Polymerase Chain Reaction Test.
Pathogena
b
Entero/rhinovirus
Influenza A
Respiratory syncytial virus
Parainfluenza
Influenza B
Other viral pathogensc
Mycoplasma pneumoniae
RVP (n = 25)
Rapid RP (n = 28)
10 (40%)
8 (32%)
1 (4%)
1 (4%)
3 (12%
1 (4%)
0 (0%)
12 (42.9%)
4 (14.3%)
5 (17.9%)
4 (14.3%)
0 (0%)
2 (7.1%)
1 (3.6%)
Note. RVP = respiratory viral panel; rapid RP = rapid respiratory panel.
a
Each comparison was not statistically significant.
b
Both tests were not able to differentiate between enterovirus and
rhinovirus due to the cross-reactivity between the 2 viruses.
c
Other viral pathogens included adenovirus, human metapneumovirus, and
coronavirus OC43.
due to the cross-reactivity between the 2 viruses. M pneumoniae was detected in 1 patient in the rapid RP group who
was given antibiotics prior to RVP-PCR result and was continued on an appropriate regimen.
Diagnostic tests such as radiologic findings and cultures
are shown in Table 3. Out of the 140 patients included in the
study, about 86% and 46% of the patients had chest x-ray and
CT results available, respectively. While some of these tests
were questionable for pneumonia, only 6% of the available
x-rays and 31% of the CT scans were positive for pneumonia
(defined as an infiltrate or consolidation suggesting pneumonia as reported by the radiologist). Blood culture results were
only available in 77% of all the patients, with about 3% of
these results being positive. Overall, there were no differences in these diagnostic tests.
Outcomes
While there was a trend toward more diabetic patients in the
rapid RP group, this difference was not statistically significant (21.4% vs 34.3%, P = .13).
Of the 140 patients, 25 out of 70 patients (35.7%) in the
RVP group and 28 out of 70 patients (40.0%) in the rapid RP
group had a positive result. The most frequently detected viral
pathogen was enterovirus/rhinovirus followed by influenza
A, RSV, and parainfluenza virus (Table 2). Both tests are
unable to differentiate between enterovirus and rhinovirus
The median LOS was 4.5 days (IQR, 3-9 days) in the RVP
group and 5 days (IQR, 3-9 days) in the rapid RP group (P =
.78). The median duration of antibiotic use was 4 days (IQR,
2-7 days) in the RVP group and 5 days (IQR, 1-7 days) in the
rapid RP group with no significant difference (P = .8). In
terms of the secondary outcome, 45.7% of patients in the
RVP group received antibiotics before RVP-PCR test
resulted, whereas it was 50% in the rapid RP group (P = .61).
Twenty-three percent of patients in the RVP group and 27.1%
Table of Contents for the Digital Edition of Hospital Pharmacy - October 2017
Pharmacists and Medical Missions
Current FDA-Related Drug Information
Summaries of Safety Labeling Changes Approved By FDA- Boxed Warnings Highlights April-June 2017
Pharmaceutical Pipeline Update
Cholesterol Ester Transfer Protein Inhibitor Review
Formulary Drug Review
Ocrelizumab
Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review
Development of a Pharmacy Technician–Driven Program to Improve Vaccination Rates at an Academic Medical Center
Safety and Efficacy of Enoxaparin Compared With Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Hemodialysis Patients
Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center
Impact of Inpatient Automatic Therapeutic Substitutions on Postdischarge Medication Prescribing
Impact of Respiratory Viral Panel Polymerase Chain Reaction Assay Turnaround Time on Length of Stay and Antibiotic Use in Patients With Respiratory Viral Illnesses
Administration of Injectable Vitamin K Orally
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Hospital Pharmacy - October 2017 - Pharmacists and Medical Missions
Hospital Pharmacy - October 2017 - Current FDA-Related Drug Information
Hospital Pharmacy - October 2017 - Summaries of Safety Labeling Changes Approved By FDA- Boxed Warnings Highlights April-June 2017
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Hospital Pharmacy - October 2017 - Pharmaceutical Pipeline Update
Hospital Pharmacy - October 2017 - Cholesterol Ester Transfer Protein Inhibitor Review
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Hospital Pharmacy - October 2017 - Formulary Drug Review
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