Antibiotics Overuse, Elderly, PCR Multiplex, Viral Infections
Conditions
Keywords
viral infections, elderly, antibiotics overuse, PCR multiplex
Brief summary
Among winter respiratory viruses, influenza is the most common and therefore responsible for the highest mortality, but parainfluenza and RSV viruses have an even higher risk of mortality (1.6 to 1.9 times), this toll being paid mainly by the elderly and co-morbid population. Futhermore, SARS-Cov2 will probably become endemic and/or epidemic with the same targets of fragile patients. These viral infections are serious, however a bacterial co-infection worsens the prognosis even more: excess risk of mortality = 2.6, 95% CI \[1.9-3.7\]. Although rare, these co-infections are the subject of a prescription of antibiotics in more than 50% of influenza infections or other serious viral infections. Mainly due to this excess risk of mortality associated with the difficulty of diagnosing these co-infections. Proper antibiotic use requires preventing this misuse and its harmful consequences in the short and long term at all costs. It is therefore imperative to have solid (grade A) evidence showing that antibiotic therapy in viral infections is not only futile but also potentially harmful.
Interventions
DRUGantibiotic withdrawal
stop antibiotics on viral or negative results
DRUGAntibiotics
standard of care Antibiotics are : Amoxicilline-acide clavulanique : 1g x3/j, 7j or Ceftriaxone : 1g/j, 7j or Pipéracilline-Tazobactam : 4g x3/j, 7j or Pristinamycine : 1g x 3/j, 7j
Sponsors
Centre Hospitalier Universitaire, Amiens
University Hospital, Rouen
Centre Hospitalier de Beauvais
University Hospital, Caen
Hôpital Les Bateliers, CHU de Lille
Centre Hospitalier Roubaix
CH SOISSONS
Tourcoing Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients ≥ 65 years affiliated to a social security scheme * Hospitalized for a lower respiratory infection defined as: * the presence of 2 of the following 4 signs: * hyperthermia \>38°C, * hyperleukocytosis ≥12000 or ≤4000, * purulent aspirations/sputum, * rales on pulmonary auscultation indicating parenchymal damage * associated with a pulmonary image (standard X-ray, CT scan or ultrasound) * Microbiological diagnostic sample taken within 48 hours * Informed consent of the patient or their representative
Exclusion criteria
* Hospitalization planned for \< 48 hours or transfer planned to another center within 7 days * Patient in septic shock, * Febrile aplasia * Absence of diagnostic microbiological sampling (\> 48 hours after admission) * Moribund patient, * Death expected within the week * Inhalation proven by endoscopy or eyewitness * Purulent pleurisy, lung abscess, or other concomitant bacterial infection requiring antibiotic therapy.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of days without antibiotics | day 30 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| number of side effects of antibiotics | day 30 | — |
| Mortality at M1 | day 30 | — |
| martality at day 180 | day 180 | — |
| Length of hospitalization in acute care | day 30 | Length of hospitalization in acute care (days) |
Countries
France
Contacts
CONTACTJean-Philippe LANOIX, Pr
Outcome results
None listed