(P32) Nursing Home Outbreak Detection and Antibiotic Use During Multipathogen Testing

Introduction/Objective: Respiratory tract infections (RTIs) significantly impact residents in nursing homes (NHs). While testing as well as prevention and control in NHs largely focus on influenza and SARS-CoV-2, there is limited understanding of the burden of other respiratory pathogens. Improved understanding of circulating respiratory pathogens in NHs may influence infection prevention and control (IPC) recommendations and antibiotic stewardship. We implemented multipathogen respiratory testing (MRT) for symptomatic residents across 4 NHs to assess RTI etiologies, with potential implications for guiding antibiotic use and outbreak management.

Design/Methodology : We conducted MRT using the cobas® eplex Respiratory Pathogen Panel 2, detecting up to 20 respiratory pathogens, for residents exhibiting new respiratory symptoms across 4 NHs in Maryland from March-September 2024. Residents also had standard NH point-of-care testing for influenza and SARS-CoV-2 as clinically indicated. Facility nursing staff collected nasal swabs from residents within 72 hours of symptom onset; specimens were processed in a central lab, with results delivered to NH clinical staff to guide clinical decision-making. Resident demographic, comorbidity, outcome, and treatment data were collected via chart review. Outbreaks were defined as ≥2 detections of the same pathogen in a 2-week period in the same NH and were considered resolved if no new cases were detected within 2 weeks of the last positive case.

Results: Among 97 MRT samples, 53 (55%) tested positive: 33 (62%) for SARS-CoV-2, 11 (21%) human metapneumovirus (hMpV), 8 (15%) parainfluenza 3, and 1 (2%) for rhinovirus/enterovirus. Seven outbreaks were identified, including 4 SARS-CoV-2 outbreaks at 3 facilities, 2 hMpV outbreaks at 2 facilities, and 1 parainfluenza outbreak. Notably, 15% (8/53) of MRT-positive residents received antibiotics, compared to 30% (13/44) of MRT-negative residents.

Conclusion/Discussion : The findings suggest that identifying a viral etiology through MRT may inform the decision to start antibiotics in NH residents with respiratory symptoms. MRT could provide additional value by detecting a broader range of viral infections, potentially aiding in outbreak management and antibiotic stewardship. Further study is warranted to assess the added benefit of MRT over standard testing methods in guiding clinical decisions.