Prevalence and predictors of antibiotic prescription among patients hospitalized with viral lower respiratory tract infections in Southern Province, Sri Lanka

PLoS One. 2024 Jun 11;19(6):e0304690. doi: 10.1371/journal.pone.0304690. eCollection 2024.

Abstract

Background: Antimicrobial overprescription is common for lower respiratory tract infections (LRTI), as viral and bacterial infections generally present with similar clinical features. Overprescription is associated with downstream antimicrobial resistance. This study aims to identify the prevalence and predictors of antibiotic prescription among patients hospitalized with viral LRTI.

Methods: A prospective cohort study was conducted among patients aged ≥1 year hospitalized with viral LRTI in a tertiary care hospital in Southern Province, Sri Lanka from 2018-2021. Demographic, clinical, and laboratory data were recorded. Nasopharyngeal and blood samples were collected for multiplex polymerase chain reaction testing for 21 respiratory pathogens and procalcitonin (PCT) detection, respectively. Demographic and clinical features associated with antibiotic prescription were identified using Chi Square and t-tests; significant variables (p<0.05) were further included in multivariable logistic regression models. The potential impact of biomarker testing on antibiotic prescription was simulated using standard c-reactive protein (CRP) and PCT cut-offs.

Results: Of 1217 patients enrolled, 438 (36.0%) had ≥1 respiratory virus detected, with 48.4% of these patients being male and 30.8% children. Influenza A (39.3%) and human rhinovirus/ enterovirus (28.3%) were most commonly detected. A total of 114 (84.4%) children and 266 (87.8%) adults with respiratory viruses were treated with antibiotics. Among children, neutrophil percentage (median 63.6% vs 47.6%, p = 0.04) was positively associated with antibiotic prescription. Among adults, headache (60.6% vs 35.1%, p = 0.003), crepitations/crackles (55.3% vs 21.6%, p<0.001), rhonchi/wheezing (42.9% vs 18.9%, p = 0.005), and chest x-ray opacities (27.4% vs 8.1%, p = 0.01) were associated with antibiotic prescription. Access to CRP and procalcitonin test results could have potentially decreased inappropriate antibiotic prescription in this study by 89.5% and 83.3%, respectively.

Conclusions: High proportions of viral detection and antibiotic prescription were observed among a large inpatient cohort with LRTI. Increased access to point-of-care biomarker testing may improve antimicrobial prescription.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents* / therapeutic use
  • C-Reactive Protein / analysis
  • C-Reactive Protein / metabolism
  • Child
  • Child, Preschool
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Prevalence
  • Procalcitonin / blood
  • Prospective Studies
  • Respiratory Tract Infections* / drug therapy
  • Respiratory Tract Infections* / epidemiology
  • Respiratory Tract Infections* / virology
  • Sri Lanka / epidemiology
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Procalcitonin
  • C-Reactive Protein

Grants and funding

This study was funded by a grant from the National Institutes of Health Fogarty Training Grant, (https://www.fic.nih.gov/Funding) #D43 TW009337 (LGT); Thrasher Research Foundation Early Career Award (https://www.thrasherresearch.org/early-career-award?lang=eng) (SV); National Institutes of Allergy and Infectious Diseases (https://www.niaid.nih.gov/) #K23AI125677 (LGT); and Duke Hubert-Yeargan Center for Global Health (https://hyc.globalhealth.duke.edu). The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.