A retrospective study of influenza rapid antigen test positivity with drug prescribing and clinical symptoms

Yıl 2019, Cilt: 10 Sayı: 2, 149 - 155, 12.06.2019

Derya Bayırlı Turan , Defne Gümüş , Fatma Kalaycı Yüksek , Tuba Kuruoğlu , Ayça Pamukcu Kıvanç Şerefhanoğlu

https://doi.org/10.18663/tjcl.440549

Öz

Aim:Influenza
like illnesses (ILI) are the most prevalent reason for unnecessary antibiotic
prescribing. Our aim was to evaluate the rapid antigen test(RAT)positivity with
drug prescribing and clinical symptoms for ILI which is also a first report for
Turkey.

Material and Methods:From September 2015 to June 2017, 1200 patients with ILI were included
in this study. Nasopharyngeal swabs were taken from all enrolled patients.
Antigen test was used for rapid detection of Influenza A/B virus, and the
results were compared with clinical manifestations and drug prescriptions.  

Results:RAT
results were positive in 414 (34.5%) of 1200 patients. Fever (984
patients/82%), cough (727 patients/60.6%) and weakness (270 patients/22.5%)
were common complaints. 371 (89.6%) out of 414 RAT positive patients had fever
(p<0.01). 174 (42%) out of 414 RAT positive patients were medicated with antivirals
(p<0.01). In addition, 516 (65.6%) out of 786 RAT negative patients were
medicated with only antibacterial (p<0.01). 

Conclusion:Our results supported a positive RAT test has an improving effect on the
unnecessary antibiotic prescribing. However, in Turkey the prevalence of
antibiotic prescription rates are still very high. Therefore we suggest that,
RAT can be used effectively to reduce antibiotic usage when a quick decision is
necessary.

Anahtar Kelimeler

Influenza like illness, drug prescribing, RAT, clinical symptoms

Influenza hızlı antijen test pozitifliğinin ilaç reçetelendirilmesi ve klinik belirtiler açısından değerlendirilmesi üzerine retrospektif çalışma

Öz

Amaç:Influenza benzeri hastalıklar (ILI) akılcı olmayan antibiyotik
kullanımının en sık sebeplerindendir. Bu çalışmadaki amacımız, Türkiye’den ilk
bildirim olarak hızlı antijen testi (RAT) pozitifliğinin ilaç
reçetelendirilmesi ve klinik belirtiler ile ilişkisini incelemektir.

Gereç ve Yöntemler:Eylül 2015-Haziran 2017 tarihleri arasında ILI tanısı almış 1200
hasta bu araştırma kapsamında değerlendirilmiştir. Tüm hastalardan nazofarenkssürüntüleri
alınmış veInfluenza A/B tanısı amacıyla RAT ile incelenmiştir. Elde edilen
sonuçlar, hastaların klinik durumları ve reçetelendirilmiş ilaçlar ile
karşılaştırılarak değerlendirilmiştir.

Bulgular:RAT sonuçlarına göre 1200 ILI hastasının 414’ü (%34,5) Influenza
A/B pozitif bulunmuştur. ILI tanısı alan hastalarda en sık görülen belirtiler
ateş (984 hasta-%82), öksürük (727 hasta-%60,6) ve halsizlik (270 hasta-%22,5)
olarak saptanmıştır. 414 RAT pozitif saptanan hastanın 371’inde (%89,6) ateş en
sık saptanan belirti olmuştur (p<0,01). Bunun yanısıra 786 RAT negatif
hastanın 516’sına (%65,6) sadece antibakteriyel ilaç reçeteverilmiştir
(p<0,01).

Sonuç:Sonuçlarımız RAT pozitifliğinin gereksiz antibiyotik
reçetelendirilmesi üzerine olumlu bir etkiye sahip olduğunu göstermiştir. Buna
rağmen Türkiye’de klinisyenlerin antibiyotik reçetelendirme oranları yüksektir.
Sonuç olarak çalışmamızinfluenza tanısınahızla karar verilmesi gereken
durumlarda RAT kullanımının gereksiz antibiyotik reçetelendirilme oranlarını
düşüreceğini göstermiştir. 

Anahtar Kelimeler

RAT, influenza benzeri hastalık, ilaç reçetelendirilmesi, RAT, klinik belirtiler

Kaynakça

• 1. Sakai T, Suzuki H, Sasaki A et al. Geographic and temporal trends in influenza like illness, Japan, 1992-1999. Emerg Infect Dis 2004; 10: 1822-26
• 2. World Health Organization. Influenza virus infections in humans (AccessedFebruary 2014). Available at <www.who.int/influenza/human_animal_interface/virology_laboratories_and_vaccines/influenza_virus_infections_humans_feb14.pdf.>AccessedMarch 02,2018.
• 3. Ortiz JR, Sotomayor V, Uez OC et al. Strategy to enhance influenza surveillance worldwide Emerg Infect Dis 2009; 15: 1271–78
• 4. Centers for Disease Control and Prevention. Evaluation of 11 commercially available rapid influenza diagnostic tests – United States, 2011-2012. MMWR. 2012; 61:873-76. Available at <www.cdc.gov/mmwr/preview/ mmwrhtml/mm6143a3.htm>Accessed March 02,2018.
• 5. Zhang Y, Li L, Dong X et al. Influenza surveillance and incidence in a rural area in China during the 2009/2010 influenza pandemic. PloS One 2014; 9: 115347.
• 6. Canavaggioa P, Boutolleaub D, Gouleta CH et al. Procalcitonin for clinical decisions on influenza-like illness in emergency department during influenza a (H1N1) 2009 pandemic. Biomarkers 2018; 23: 10-13.
• 7. Drinka PJ, Gravenstein S, Krause P et al. Non-influenza respiratory viruses may overlap and obscure influenza activity. J Am Geriatr Soc 1999; 47: 1087–93.
• 8. Monto A, Gravenstein S, Elliott M et al. Clinical signs and symptoms predicting influenza infection. Arch Intern Med 2000; 160: 3243–47.
• 9. Kelly H, Birch C. The causes and diagnosis of influenza-like illness. Aust Fam Physician 2004; 33: 305–309.
• 10. World Health Organization. Influenza Update N° 291. 2017. Available at <www.who.int/influenza/surveillance_monitoring/updates/2017_06_12_surveillance_update_291.pdf.> Accessed March 02,2018.
• 11. Fiore AE, Fry A, Shay D et al. Antiviral agents for the treatment and chemoprophylaxis of influenza—recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60: 1–24.
• 12. Bonner AB, Monroe KW, Talley LI et al. Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics 2003; 112: 363–67.
• 13. Jennings LC, Skopnik H, Burckhardt I et al. Effect of rapid influenza testing on the clinical management of paediatric influenza. Influenza Other Respir Viruses 2009; 3: 91–98.
• 14. Akazawa M, Sindelar JL, Paltiel AD. Economic costs of influenza-related work absenteeism, Value Health 2003; 6: 107–15.
• 15. Dutkowski R. Oseltamivir in seasonal influenza: cumulative experience in low-and high-risk patients. J Antimicrob Chemother 2010; 65: 11-24.
• 16. Peters PH, Moscona A, Schulman KL, Barr CE. Study of the impact of oseltamivir on the risk for pneumonia and other outcomes of influenza, 2000-2005. Medscape J Med 2008; 10: 131.
• 17. Glezen WP. Clinical practice. Prevention and treatment of seasonal influenza, N. Engl J Med 2008; 359: 2579–85.
• 18. Committee on Infectious Diseases. Reduction of the influenza burden in children. Pediatrics 2002; 110: 1246-52.
• 19. Chartrand C, Leeflang MM, Minion J et al. Accuracy of rapid influenza diagnostic tests: a meta-analysis. Ann Intern Med 2012; 156: 500–11.
• 20. World Health Organization.2005. Recommendations on the use of rapid testing for influenza diagnosis; Geneva. Available at <www.who.int/influenza/resources/documents/RapidTestInfluenza_WebVersion.pdf> Accessed March 12,2018.
• 21. <http://www.ieis.org.tr/ieis/tr/indicators/33/turkiye-ilac-pazari> Accessed March 12,2018.
• 22. Barenfanger J, Drake C, Mueller T et al. R-Mix cells are faster, at least as sensitive and marginally more costly than conventional cell lines for the detection of respiratory viruses. J Clin Virol 2001; 22: 101–10.
• 23. <https://www.alere.com/en/home/product-details/sd-bioline-influenza-ag.html> Accessed April 12, 2018.
• 24. <https://www.cdc.gov/flu/professionals/diagnosis/rapidlab.htm> Accessed on 12 April 2018.
• 25. Cao B, Li XW, Mao Y et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. New England Journal of Medicine 2009; 361: 2507-17.
• 26. Human infection with new influenza A (H1N1) virus: clinical observations from a school-associated outbreak in Kobe, Japan, May 2009. Wkly Epidemiol Rec 2009; 84: 237-44.
• 27. D’Heilly SJ, Janoff EN, Nichol P et al. Rapid diagnosis of influenza infection in older adults: influence on clinical care in a routine clinical setting. J ClinVirol 2008; 42: 124–28.
• 28. Ciblak MA, Albayrak N, Odabas Y et al. Cases of influenza A (H1N1) v reported in Turkey, May-July 2009. Eurosurveillance 2009; 14: 19304.
• 29. Echevarría-Zuno S, Mejía-Aranguré JM, Mar-Obeso AJ et al. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis. The Lancet 2009; 374: 2072-79.
• 30. Falsey AR, Murata Y, Walsh EE. Impact of rapid diagnosis on management of adults hospitalized with influenza. Arch Intern Med 2007; 167: 354-60.
• 31. Call SA, Vollenweider MA, Hornung CA, et al. Does this patient have influenza? JAMA 2005; 293: 987-97.
• 32. Rothberg MB, Bellantonio S Rose DN. Management of influenza in adults older than 65 years of age: cost-effectiveness of rapid testing and antiviral therapy. Ann Intern Med 2003; 139: 321-29.
• 33. Castilla J, Martínez-Baz I, Navascués A et al. Network for Influenza Surveillance in Hospitals of Navarre. Comparison of influenza vaccine effectiveness in preventing outpatient and inpatient influenza cases in older adults, northern Spain, 2010/11 to 2015/16. Eurosurveillance 2018; 23(2): 16-780.
• 34. Yıldırım D, Özdoğru DS, Şeflek B et al. Detection of influenza virus infections by molecular and immunofluorescence methods. Mikrobiyoloji Bulteni 2017; 51: 370-77.
• 35. Lee N, Choi KW, Chan PKS et al. Outcomes of adults hospitalised with severe influenza. Thorax 2010; 65: 510-15.
• 36. Mese S, Akan H, Badur S et al. Analytical performance of the BD veritor™ system for rapid detection of influenza virus A and B in a primary healthcare setting. BMC Infectious Diseases2016; 16: 481.
• 37. Ndegwa LK, Emukule G, Uyeki TM et al. Evaluation of the point-of-care Becton Dickinson Veritor™ Rapid influenza diagnostic test in Kenya, 2013–2014. BMC Infectious Diseases 2017; 17: 60.
• 38. Stein J, Louie J, Flanders S et al. Performance characteristics of clinical diagnosis, a clinical decision rule, and a rapid influenza test in the detection of influenza infection in a community sample of adults. Annals of Emergency Medicine 2005; 46: 412-19.
• 39. Duman M, Gençpinar P, Özbek ÖA et al. Value of rapid antigen test for pandemic influenza A (H1N1) 2009 in the pediatric emergency department. Pediatric Emergency Care 2013; 29: 612-16.
• 40. Versporten A, Bolokhovets G, Ghazaryan L et al. Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO regional Office for Europe. Lancet Infect Dis 2014; 14: 381-87.
• 41. <http://www.tuba.gov.tr/tr/yayinlar/suresiz-yayinlar/raporlar/tuba-insan-ve-hayvan-sagliginda-akilci-antibiyotik-kullanimi-ve-antibiyotik-direnclilik-raporu> Accessed August 03, 2018.
• 42. Ciesla G, Leader S, Stoddard J. Antibiotic prescribing rates in the US ambulatory care setting for patients diagnosed with influenza, 1997–2001. Respir Med 2004; 98: 1093–101.