Comparative antimicrobial use in coronavirus disease 2019 (COVID-19) and non-COVID-19 inpatients from 2019 to 2020: A multicenter ecological study
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Carlos A Q Santos1, Marion Tseng2, Ashley I Martinez3,4
1Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
Insights
Antimicrobial use increased in COVID-19 patients but decreased in non-COVID-19 patients during the pandemic. This study analyzed antimicrobial prescribing patterns in hospitalized patients during the COVID-19 pandemic.
Area of Science:
- Infectious Diseases
- Hospital Administration
- Public Health
Background:
- The onset of the coronavirus disease 2019 (COVID-19) pandemic led to increased antimicrobial use globally.
- It remains unclear whether this rise in antimicrobial prescribing was confined to COVID-19 patients or also affected non-COVID-19 patient populations.
Purpose of the Study:
- To investigate if increased antimicrobial use during the COVID-19 pandemic was solely driven by higher prescribing in COVID-19 patients.
- To determine if antimicrobial use also increased in non-COVID-19 patients during the pandemic.
Main Methods:
- A retrospective observational ecological study was conducted from March to December 2019 and March to December 2020.
- Inpatients were stratified by COVID-19 status across three acute-care hospitals in Chicago, Illinois.
- Median monthly antimicrobial use was compared between COVID-19 and non-COVID-19 patients, and between pandemic and pre-pandemic periods using Wilcoxon signed-rank tests.
Main Results:
- Antimicrobial use for broad-spectrum agents was significantly higher in COVID-19 patients compared to non-COVID-19 patients during the pandemic.
- Relative increases in broad-spectrum antimicrobial use for COVID-19 patients ranged from 66% to 91% across the three hospitals.
- Conversely, overall antimicrobial use in non-COVID-19 patients decreased by 7-8% during the pandemic compared to the pre-pandemic period.
Conclusions:
- The pandemic saw increased use of broad-spectrum antimicrobials in COVID-19 patients.
- Antimicrobial prescribing for non-COVID-19 patients actually decreased during the COVID-19 pandemic.
- These findings highlight differential impacts of the pandemic on antimicrobial stewardship across patient groups.
Objective:
We sought to determine whether increased antimicrobial use (AU) at the onset of the coronavirus disease 2019 (COVID-19) pandemic was driven by greater AU in COVID-19 patients only, or whether AU also increased in non-COVID-19 patients.
Design:
In this retrospective observational ecological study from 2019 to 2020, we stratified inpatients by COVID-19 status and determined relative percentage differences in median monthly AU in COVID-19 patients versus non-COVID-19 patients during the COVID-19 period (March-December 2020) and the pre-COVID-19 period (March-December 2019). We also determined relative percentage differences in median monthly AU in non-COVID-19 patients during the COVID-19 period versus the pre-COVID-19 period. Statistical significance was assessed using Wilcoxon signed-rank tests.
Setting:
The study was conducted in 3 acute-care hospitals in Chicago, Illinois.
Patients:
Hospitalized patients.
Results:
Facility-wide AU for broad-spectrum antibacterial agents predominantly used for hospital-onset infections was significantly greater in COVID-19 patients versus non-COVID-19 patients during the COVID-19 period (with relative increases of 73%, 66%, and 91% for hospitals A, B, and C, respectively), and during the pre-COVID-19 period (with relative increases of 52%, 64%, and 66% for hospitals A, B, and C, respectively). In contrast, facility-wide AU for all antibacterial agents was significantly lower in non-COVID-19 patients during the COVID-19 period versus the pre-COVID-19 period (with relative decreases of 8%, 7%, and 8% in hospitals A, B, and C, respectively).
Conclusions:
AU for broad-spectrum antimicrobials was greater in COVID-19 patients compared to non-COVID-19 patients at the onset of the pandemic. AU for all antibacterial agents in non-COVID-19 patients decreased in the COVID-19 period compared to the pre-COVID-19 period.
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