Association between SARS-CoV-2 testing and antibiotic use in Swiss long-term care facilities: a retrospective...

Acute respiratory infections (ARIs) account for 30% of long-term care facility (LTCF) infections, frequently leading to antibiotics over-prescription.

This study evaluates the impact of SARS-CoV-2 testing on LTCF antibiotic prescriptions.

A retrospective study was conducted across 45 LTCFs in Vaud Canton, Switzerland, encompassing 2427 long-stay beds, from July 2021 to June 2023. Monthly data on SARS-CoV-2 tests and antibiotic prescriptions were collected. Using linear regression adjusted for Swiss viral epidemiology, we assessed the association between (i) SARS-CoV-2 testing and (ii) positive test results on antibiotic prescriptions.

SARS-CoV-2 testing rates in LTCFs varied, ranging from 0.3% to 16% of residents tested per facility, peaking in January 2022, July 2022, and November 2022. Similar trends were observed for SARS-CoV-2 test positivity, except for the last testing peak. Antibiotic prescription rates fluctuated moderately, from 3.9% to 7.4% monthly, with minor peaks in December 2021 and April 2022, and a notable peak in January 2023.No significant association was found between SARS-CoV-2 testing and antibiotic prescriptions (coefficient = -0.03 [95%CI: -0.16; 0.10], P = 0.65). However, positive SARS-CoV-2 tests were negatively associated with prescriptions (coefficient = -0.28 [95%CI: -0.53; -0.03], P = 0.029); a 10% increase in positive tests is associated with a 2.8% reduction in antibiotic prescriptions, with an estimated 3.5 positive tests needed to prevent one prescription.

Overall testing rates showed no impact on antibiotic prescribing, but positive SARS-CoV-2 results correlated with reduced consumption, suggesting more informed prescribing practices and a reduction in unnecessary antibiotic use.