Change in Antimicrobial Use During COVID-19 Pandemic in South Carolina Hospitals: A Multicenter Observational Cohort Study

Abstract

This retrospective cohort study examined the impact of the pandemic on antimicrobial use (AU) in South Carolina hospitals. AU 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) to that during the same months in 2019 in hospitals that did and did not admit patients with COVID-19. There was a 6.6% increase in overall AU in the 7 hospitals admitting patients with COVID-19 (from 530.9 to 565.8; mean difference: 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 (mean difference 6.0 DOT/1000 days-present, 95% CI: -55.5, 67.6; p=0.83). Most of the increase in AU in the 7 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; mean difference: 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-MRSA agents (from 66.7 to 73.3; mean difference: 6.6 DOT/1000 days-present, 95% CI: 2.3, 10.8; p=0.01). 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.

A multicenter evaluation of antibacterial use in hospitalized patients through the SARS-Cov-2 pandemic waves

“…Our results con rmed the ndings of other studies that demonstrated an initial increase in antibiotic use during the early pandemic period, particularly among SARS-2-CoV-positive patients [3,4,13], followed by a subsequent decrease in later pandemic periods [3]. Rates of GN/GP positivity in SARS-2-CoV-positive patients were 13.3% between March 2020 and May 2020, which decreased to 11.0% between June 2021 and October 2021, while rates of antibiotic prescriptions decreased from 68.0-53.6% over the same period.…”

“…However, a study of changes in inpatient antimicrobial use in 17 hospitals in South Carolina (7 that admitted patients with COVID-19 and 10 that did not) reported a 6.6% increase in antimicrobial use between March and June 2020 compared to the same time period in 2019 [13]. Among the 7 hospitals that admitted patients with COVID-19, a 9.9% increase in the use of broad-spectrum GP agents was observed compared to 2019.…”

Changes in intravenous and oral antimicrobial prescriptions during the coronavirus disease 2019 (COVID-19) pandemic: an experience at a tertiary-care center

“…Although a previous study demonstrated increased use of antimicrobials in patients with COVID-19 requiring hospitalization during the pandemic, 7,8 these findings have some unique implications. We observed a decrease in the use of ceftriaxone and azithromycin, which were treatment options for community-acquired pneumonia (CAP) related to COVID-19.…”

The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections: a narrative review

“…Hospitals that did not admit patients with COVID-19 saw no change in their antibiotic utilization during these time periods. 98 Increased antibiotic use during COVID-19 has also been described in Portugal, 99 the Netherlands, 100 elsewhere in the USA 41 , 101–103 and Singapore, 104 often with a specific increase in broad-spectrum antibiotics. 105 This increase persisted despite a paucity of data regarding antibiotic efficacy 106 and multiple studies showing that less than 7% of patients with COVID-19 had a concomitant bacterial infection upon admission.…”