Combining an antibiotic stewardship program with a 15-pathogen viral panel to reduce inappropriate antibiotic prescribing.

Acute upper respiratory tract infections (ARI) frequently result in unnecessary antibiotic prescribing in outpatient settings, contributing to antibiotic resistance and avoidable adverse outcomes. While antimicrobial stewardship programs (ASPs) have shown promise, their implementation in urgent care settings remains limited. The impact of point-of-care (POC) respiratory viral panels on antibiotic prescribing is also uncertain. This study evaluates the effect of the BIOFIRE SPOTFIRE Respiratory Panel, a 15-pathogen panel, with integrated ASP interventions on antibiotic prescribing in a high-volume urgent care setting in the Southeast United States. This was a prospective cohort study of adults with ARI who presented to an urgent care in Louisiana from June to August 2024. A randomly selected, seasonally matched, historic usual care group served as a control group. We compared the impact of BIOFIRE SPOTFIRE Respiratory Panel testing and ASP on antibiotic prescribing. A total of 296 patients were prospectively enrolled, with 600 randomly selected historical controls. The intervention group had a significantly lower antibiotic prescribing rate (24.3% vs 38.2%; adjusted odds ratio (aOR) 0.50, 95% confidence interval (CI) 0.36-0.68) and inappropriate antibiotic use rate (15.9% vs 30.8%; aOR 0.39, 95% CI 0.28-0.57) compared to controls. Steroid prescribing also decreased (17.9% vs 29.0%; aOR 0.55, 95% CI 0.39-0.78). Implementation of a POC multirespiratory pathogen molecular test combined with an ASP intervention significantly reduced antibiotic and steroid prescribing in a high-volume urgent care setting. IMPORTANCE: Acute upper respiratory tract infections are common and often result in unnecessary antibiotic prescribing. We found a significant reduction in inappropriate antibiotic use after implementing an antibiotic stewardship program with a point-of-care respiratory viral panel in an urgent care setting.