Abstract Objectives Virus infection is underevaluated in older adults with severe acute respiratory infections (SARIs). We aimed to evaluate the clinical impact of combining point-of-care molecular viral test and serum procalcitonin (PCT) level for antibiotic stewardship in the emergency department (ED). Design A prospective twin-center cohort study was conducted between January 2017 and March 2018. Setting and Participants Older adult patients who presented to the ED with SARIs received a rapid molecular test for 17 respiratory viruses and a PCT test. Measures To evaluate the clinical impact, we compared the outcomes of SARI patients between the experimental cohort and a propensity score–matched historical cohort. The primary outcome was the proportion of antibiotics discontinuation or de-escalation in the ED. The secondary outcomes included duration of intravenous antibiotics, length of hospital stay, and mortality. Results A total of 676 patients were included, of which 169 patients were in the experimental group and 507 patients were in the control group. More than one-fourth (27.9%) of the patients in the experimental group tested positive for virus. Compared with controls, the experimental group had a significantly higher proportion of antibiotics discontinuation or de-escalation in the ED (26.0% vs 16.1%, P = .007), neuraminidase inhibitor uses (8.9% vs 0.6%, P < .001), and shorter duration of intravenous antibiotics (10.0 vs 14.5 days, P < .001). Conclusions and Implications Combining rapid viral surveillance and PCT test is a useful strategy for early detection of potential viral epidemics and antibiotic stewardship. Clustered viral respiratory infections in a nursing home is common. Patients transferred from nursing homes to ED may benefit from this approach.

中文翻译：

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结合降钙素原和快速多重呼吸道病毒检测对老年严重急性呼吸道感染患者的抗生素管理

摘要 目的 在患有严重急性呼吸道感染 (SARIs) 的老年人中，病毒感染被低估了。我们旨在评估结合即时分子病毒检测和血清降钙素原 (PCT) 水平对急诊科 (ED) 抗生素管理的临床影响。设计 在 2017 年 1 月至 2018 年 3 月期间进行了一项前瞻性双中心队列研究。 设置和参与者 出现 SARI 的老年患者接受了 17 种呼吸道病毒的快速分子检测和 PCT 检测。措施 为了评估临床影响，我们比较了实验队列和倾向评分匹配的历史队列之间的 SARI 患者的结果。主要结果是 ED 中抗生素停用或降级的比例。次要结果包括静脉注射抗生素的持续时间、住院时间和死亡率。结果共纳入676例患者，其中实验组169例，对照组507例。实验组中超过四分之一（27.9%）的患者病毒检测呈阳性。与对照组相比，实验组在 ED 中抗生素停用或降级的比例显着更高（26.0% 对 16.1%，P = .007），神经氨酸酶抑制剂的使用（8.9% 对 0.6%，P < .001） ，以及更短的静脉抗生素持续时间（10.0 天 vs 14.5 天，P < .001）。结论和意义 结合快速病毒监测和 PCT 检测是早期检测潜在病毒流行和抗生素管理的有用策略。疗养院中的聚集性病毒性呼吸道感染很常见。从疗养院转移到 ED 的患者可能会受益于这种方法。