Predictors of antibiotic prescription for upper respiratory infections in cancer patients.

Background: Limited data regarding predictors of antibiotic prescription for acute upper respiratory infections (URI) are available for ambulatory patients with cancer. Methods: Adult cancer patients with URI who presented to the Urgent Care Center or Symptom Care Clinic (SCC) and had a respiratory pathogen panel (RPP) between September 1, 2019 and March 11, 2020, were evaluated. Patients were dichotomized by receipt of antibiotic prescription (yes vs no). Demographics, cancer treatment, URI characteristics, and URI management were compared by Student's t test or Mann-Whitney U test and χ2 or Fisher's exact test as appropriate. Logistic regression was performed to evaluate predictors of antibiotic prescription. Results: Of 552 patients, 384 (69.6%) received cancer treatment within 30 days of the URI, and 377 (68.3%) had a positive RPP result. Antibiotics were prescribed in 156 (28.3%) patients, and 26/156 (16.7%) were appropriate. Multivariate logistic regression showed that predictors of antibiotic prescribing included SCC visit location (odds ratio (OR) 2.09, 95% confidence interval (CI) 1.30-3.38), symptom duration >7 days (OR 2.29, 95% CI 1.26 - 4.17), earache (OR 9.30, 95% CI 3.47 - 24.93), sinus symptoms (OR 2.64, 95% CI 1.53 - 4.56), negative RPP result (OR 1.88, 95% CI 1.18 - 2.98), and negative RPP result for influenza (OR 3.31, 95% CI 1.53 - 7.16). Conclusions: Almost one-third of outpatients at a single cancer center were prescribed antibiotics for URI with only 16.7% being appropriate. Getting real-time RPP results can be helpful to optimize antibiotic prescribing. Understanding risk factors for antibiotic prescribing in ambulatory cancer patients with URI may better direct antimicrobial stewardship efforts.