Sinus infections are one of the most common reasons patients walk out of the doctor’s office with an antibiotic prescription in hand. The problem is that bacteria causes only about one-third of sinus infections, which means most patients are inappropriately receiving antibiotics. To curb unnecessary antibiotic prescribing, physician and University of Georgia researcher Mark Ebell developed a clinical decision rule for diagnosing sinus infections, or acute rhinosinusitis. In a study appearing in the Annals of Family Medicine, Ebell presents a series of simple clinical rules that integrate patient symptoms and simple lab tests to accurately detect acute bacterial rhinosinusitis.
“A lot of the signs and symptoms of a bacterial sinus infection can be similar to those of a viral respiratory infection,” said Ebell, who is a professor of epidemiology at UGA’s College of Public Health. “It can be difficult to distinguish between the two just using individual signs and symptoms.”
Though primary practice guidelines only recommend the use of antibiotics for patients who have experienced prolonged or severe symptoms, an estimated 72 percent of patients receive an antibiotic. Unnecessary antibiotic use is one of the leading contributors to antibiotic-resistant infections, according to the Centers for Disease Control and Prevention.
“Patients have been conditioned to expect an antibiotic for sinus infections because that’s what doctors do,” Ebell said, “so the goal of our research was to help identify patients who didn’t need an antibiotic.”
To develop a clinical decision rule for acute bacterial rhinosinusitis, Ebell needed to determine which combination of symptoms and tests best predicted the presence of bacteria and compare the statistical predictor to a reference standard, which is used to confirm its accuracy. A positive bacterial culture of sinus fluid was the preferred reference standard in this study.
He and his colleague, Dr. Jens Hansen of Aarhaus University Hospital in Denmark, recorded the symptoms and C-reactive protein levels for 175 patients suspected of having sinus infections. Based on these data, Ebell created a point score that can be used to determine the likelihood that a patient is at low, moderate or high risk for bacterial infection.
CRP tests detect inflammation in the body, which can indicate an infection. This is an important component of the point score, Ebell said, though CRP testing is currently unavailable in most primary care settings in the U.S.
“That’s one of the issues we wanted to call attention to,” he said. “This is a test that’s widely used by doctors in Europe, the U.K. and Australia, and has been shown to decrease inappropriate antibiotic use.”
Approximately half of patients in the study had a low score, meaning they were low-risk for bacterial infection. Withholding antibiotics from this group could cut the proportion of patients receiving antibiotics in half.
Ebell said that physicians can easily incorporate this point score into clinical practice. A nurse or medical assistant can identify whether patients are experiencing any of five symptoms –previous upper respiratory or sinus infections, discolored mucus, pain in the area under the eyes, or a toothache – during the initial interview. Then, the physician could decide whether to order a CRP test and determine a final score for sinus infection.
CRP tests have been shown to help better diagnose lower respiratory infections, pneumonia and, now, acute bacterial rhinosinusitis. Ebell hopes this study will encourage the Food and Drug Administration to loosen restrictions on its use in primary care clinics.
“If you can show a patient that his or her inflammation level is low, which makes bacteria an unlikely cause of infection, then I think patients might be more willing to accept not getting an antibiotic,” he said.
Ebell’s next plan is to perform a randomized clinical trial to test the effectiveness of the point score system, including the use of a CRP test, in clinical practice.
“We need to give physicians better tools to support their decision-making, and that can include clinical decision rules and point of care tests like CRP,” Ebell said. “Using these kinds of tools, we can hopefully reduce unnecessary antibiotic use.”
The study, “Proposed Clinical Decision Rules to Diagnose Acute Rhinosinusitis Among Adults in Primary Care,” is available online at http://www.annfammed.org/content/15/4/347/.
Source: University of Georgia
Dear Helpdesk: Working in a Toxic Health Care Environment
March 28th 2024Dear Helpdesk is your steadfast companion, offering life coaching and workplace advice from 2 seasoned IPs for some of your most challenging real-life situations. Let us help you navigate the intersection between work and life, guiding you to navigate the dynamic world of infection prevention with confidence and grace. This article is on handling a toxic health care environment.
Product Locator: Spring and Early Mother's Day Gift Guide for Infection Prevention Personnel
March 27th 2024Whether it's a spring holiday, birthdays, or no reason at all, infection prevention personnel love to give and receive gifts that help at the end of a stressful day. Infection Control Today® offers some gift ideas for infection prevention personnel and their families.
Catching Up With Vangie Dennis, AORN 2022-2023 President at AORN 2024
March 26th 2024Infection Control Today (ICT) had the privilege of catching up with Vangie Dennis, MSN, RN, CNOR, CMLSO, at the Association of periOperative Registered Nurses' (AORN’s) International Surgical Conference & Expo 2024. As the former president of AORN and an esteemed figure in perioperative services, Vangie Dennis shared insights into her recent endeavors and the exciting new chapter she's embarked upon.
How To Optimize Your Time Management Strategies for the Busy Infection Preventionist
March 25th 2024Is your calendar resembling a chaotic masterpiece of overlapping tasks? Join the club of infection preventionists striving to balance responsibilities. Dive into proven strategies from a fellow infection preventionist to reclaim control of your time, streamline tasks, and boost productivity effectively. This is an IP Lifeline article.