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Change in Antimicrobial Use During COVID-19 Pandemic in South Carolina Hospitals: A Multicenter Observational Cohort
Hana R Winders1, Pamela Bailey2, Joseph Kohn3
1Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA; Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA.
Objectives:
This retrospective cohort study examined the impact of the pandemic on antimicrobial use (AU) in South Carolina hospitals.
Methods:
Antimicrobial use in days of therapy (DOT) per 1000 days-present was evaluated in 17 hospitals in South Carolina. Matched-pairs mean difference was used to compare AU during the pandemic (March-June 2020) with that during the same months in 2019 in hospitals that did and did not admit patients with COVID-19.
Results:
There was a 6.6% increase in overall AU in the seven hospitals that admitted patients with COVID-19 (from 530.9 to 565.8; mean difference (MD) 34.9 DOT/1000 days-present; 95% CI 4.3, 65.6; P = 0.03). There was no significant change in overall AU in the remaining 10 hospitals that did not admit patients with COVID-19 (MD 6.0 DOT/1000 days-present; 95% CI -55.5, 67.6; P = 0.83). Most of the increase in AU in the seven hospitals that admitted patients with COVID-19 was observed in broad-spectrum antimicrobial agents. A 16.4% increase was observed in agents predominantly used for hospital-onset infections (from 122.3 to 142.5; MD 20.1 DOT/1000 days-present; 95% CI 11.1, 29.1; P = 0.002). There was also a 9.9% increase in the use of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents (from 66.7 to 73.3; MD 6.6 DOT/1000 days-present; 95% CI 2.3, 10.8; P = 0.01).
Conclusion:
The COVID-19 pandemic appears to drive overall and broad-spectrum antimicrobial use in South Carolina hospitals admitting patients with COVID-19. Additional antimicrobial stewardship resources are needed to curtail excessive antimicrobial use in hospitals to prevent subsequent increases in antimicrobial resistance and Clostridioides difficile infection rates, given the continuing nature of the pandemic.
Insights
The COVID-19 pandemic increased antimicrobial use in South Carolina hospitals that treated COVID-19 patients. This rise in antimicrobial use, particularly broad-spectrum agents, necessitates enhanced stewardship to prevent antimicrobial resistance.
Area of Science:
- Infectious Diseases
- Epidemiology
- Hospital Administration
Background:
- The COVID-19 pandemic has presented unprecedented challenges to healthcare systems globally.
- Understanding the impact of the pandemic on antimicrobial use (AU) is crucial for managing hospital-acquired infections and antimicrobial resistance (AMR).
Purpose of the Study:
- To evaluate the effect of the COVID-19 pandemic on antimicrobial utilization in South Carolina hospitals.
- To compare antimicrobial use during the pandemic period with the pre-pandemic period in hospitals with and without COVID-19 admissions.
Main Methods:
- A retrospective cohort study design was employed, analyzing data from 17 hospitals in South Carolina.
- Antimicrobial use was measured in days of therapy (DOT) per 1000 days-present.
- Matched-pairs mean difference analysis compared AU between March-June 2020 (pandemic) and March-June 2019 (pre-pandemic).
Main Results:
- Hospitals admitting COVID-19 patients experienced a significant 6.6% increase in overall AU (34.9 DOT/1000 days-present; P=.03).
- A notable rise in broad-spectrum antimicrobial agents (16.4% increase) and anti-MRSA agents (9.9% increase) was observed in these hospitals.
- Hospitals without COVID-19 admissions showed no significant change in overall AU (P=.83).
Conclusions:
- The COVID-19 pandemic is associated with increased overall and broad-spectrum antimicrobial use in South Carolina hospitals that admitted COVID-19 patients.
- Enhanced antimicrobial stewardship programs are essential to mitigate excessive antimicrobial prescribing and prevent future increases in antimicrobial resistance and Clostridioides difficile infections.
- The findings underscore the need for ongoing vigilance and resource allocation for antimicrobial stewardship during and after the pandemic.
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