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Association between SARS-CoV-2 testing and antibiotic use in Swiss long-term care facilities: a retrospective
Marc Jeanneret1, Alexia Roux2, Isabella Locatelli3
1Faculty of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Background:
Acute respiratory infections (ARIs) account for 30% of long-term care facility (LTCF) infections, frequently leading to antibiotics over-prescription.
Objectives:
This study evaluates the impact of SARS-CoV-2 testing on LTCF antibiotic prescriptions.
Methods:
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.
Results:
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.
Conclusions:
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.
Insights
SARS-CoV-2 testing in long-term care facilities did not impact antibiotic prescriptions. However, a rise in positive SARS-CoV-2 tests correlated with reduced antibiotic use, indicating more informed prescribing.
Area of Science:
- Infectious Disease Epidemiology
- Antimicrobial Stewardship
- Public Health in Long-Term Care Facilities
Background:
- Acute respiratory infections (ARIs) constitute 30% of infections in long-term care facilities (LTCFs), often leading to antibiotic overuse.
- Antibiotic resistance is a growing concern, particularly in vulnerable populations residing in LTCFs.
Purpose of the Study:
- To investigate the association between SARS-CoV-2 testing and antibiotic prescription patterns in Swiss LTCFs.
- To determine if SARS-CoV-2 diagnostic efforts influence the rate of antibiotic prescribing.
Main Methods:
- A retrospective study analyzed monthly data from 45 LTCFs in Switzerland (July 2021-June 2023).
- Linear regression models, adjusted for local viral epidemiology, assessed the impact of SARS-CoV-2 testing volume and positivity on antibiotic prescriptions.
Main Results:
- While overall SARS-CoV-2 testing rates did not correlate with antibiotic prescriptions, a significant negative association was found between positive SARS-CoV-2 test results and antibiotic prescriptions (P=0.029).
- A 10% increase in positive SARS-CoV-2 tests was linked to a 2.8% decrease in antibiotic prescriptions.
- An estimated 3.5 positive SARS-CoV-2 tests were needed to prevent one antibiotic prescription.
Conclusions:
- Widespread SARS-CoV-2 testing alone did not reduce antibiotic prescribing in LTCFs.
- Positive SARS-CoV-2 diagnostic results appear to promote more judicious antibiotic prescribing, potentially by clarifying the etiology of respiratory symptoms and reducing unnecessary treatments.
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