BACKGROUND Outpatient antibiotic prescribing for acute upper respiratory infections (URI) is a high priority target for antimicrobial stewardship that has not been described for cancer patients. METHODS We conducted a retrospective cohort study of adult patients at an ambulatory cancer center with ICD-10 diagnosis code consistent with URI from October 1, 2015 to September 30, 2016. We obtained antimicrobial prescribing, respiratory viral testing, and other clinical data at first encounter for the URI through day 14. We used generalized estimating equations to test associations of baseline factors with antibiotic prescribing. RESULTS Of 341 charts reviewed, 251 (74%) patients were eligible for analysis. Nearly one-third (32%) of patients were prescribed antibiotics for URI. Respiratory viruses were detected among 85 (75%) of 113 patients tested. Antibiotic prescribing (p=0.001) and viral testing (p<0.001) varied by clinical service. Sputum production or chest congestion was associated with higher risk of antibiotic prescribing (RR=2.3, 95% CI 1.4-3.8, p<0.001). Viral testing on day 0 was associated with lower risk of antibiotic prescribing (RR=0.4, 95% CI 0.2-0.8, p=0.01) though collinearity between viral testing and clinical service limited our ability to separate these effects on prescribing. Antibiotic prescribing was not associated with subsequent URI-related healthcare visits (p=0.89). CONCLUSIONS Nearly one-third of hematology-oncology outpatients were prescribed antibiotics for URI, despite viral etiologies identified among 75% of those tested. Antibiotic prescribing was significantly lower among patients receiving an initial respiratory viral test. The role of viral testing in antibiotic prescribing for URI in outpatient oncology settings merits further study.

中文翻译：

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门诊癌症中心成人患者急性上呼吸道感染的抗生素处方和呼吸道病毒检测。

背景 急性上呼吸道感染 (URI) 的门诊抗生素处方是抗菌药物管理的高度优先目标，尚未针对癌症患者进行描述。方法 我们对 2015 年 10 月 1 日至 2016 年 9 月 30 日在门诊癌症中心进行了 ICD-10 诊断代码与 URI 一致的成年患者的回顾性队列研究。我们首先获得了抗菌药物处方、呼吸道病毒检测和其他临床数据URI 到第 14 天的遭遇。我们使用广义估计方程来测试基线因素与抗生素处方的关联。结果 在审查的 341 个图表中，251 名 (74%) 患者符合分析条件。近三分之一 (32%) 的患者因 URI 被开具抗生素处方。在接受测试的 113 名患者中，有 85 名 (75%) 检测到呼吸道病毒。抗生素处方 (p=0.001) 和病毒检测 (p<0.001) 因临床服务而异。咳痰或胸闷与较高的抗生素处方风险相关（RR=2.3，95% CI 1.4-3.8，p<0.001）。第 0 天的病毒检测与较低的抗生素处方风险相关（RR=0.4，95% CI 0.2-0.8，p=0.01），尽管病毒检测和临床服务之间的共线性限制了我们区分这些对处方的影响的能力。抗生素处方与随后的 URI 相关医疗就诊无关 (p=0.89)。结论 尽管在 75% 的测试患者中确定了病毒病因，但仍有近三分之一的血液肿瘤科门诊患者因 URI 被开具抗生素处方。在接受初始呼吸道病毒检测的患者中，抗生素处方显着减少。