Trends in hospital antibiotic utilization during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter interrupted time-series analysis

Abstract

Objective: To describe the evolution of respiratory antibiotic prescribing during the coronavirus disease 2019 (COVID-19) pandemic across 3 large hospitals that maintained antimicrobial stewardship services throughout the pandemic.

Design: Retrospective interrupted time-series analysis.

Setting: A multicenter study was conducted including medical and intensive care units (ICUs) from 3 hospitals within a Canadian epicenter for COVID-19.

Methods: Interrupted time-series analysis was used to analyze rates of respiratory antibiotic utilization measured in days of therapy per 1,000 patient days (DOT/1,000 PD) in medical units and ICUs. Each of the first 3 waves of the pandemic were compared to the baseline.

Results: Within the medical units, use of respiratory antibiotics increased during the first wave of the pandemic (rate ratio [RR], 1.76; 95% CI, 1.38-2.25) but returned to the baseline in waves 2 and 3 despite more COVID-19 admissions. In ICU, the use of respiratory antibiotics increased in wave 1 (RR, 1.30; 95% CI, 1.16-1.46) and wave 2 of the pandemic (RR, 1.21; 95% CI, 1.11-1.33) and returned to the baseline in the third wave, which had the most COVID-19 admissions.

Conclusions: After an initial surge in respiratory antibiotic prescribing, we observed the normalization of prescribing trends at 3 large hospitals throughout the COVID-19 pandemic. This trend may have been due to the timely generation of new research and guidelines developed with frontline clinicians, allowing for the active application of new research to clinical practice.

Fig. 1.

Respiratory antibiotic use in general medicine. *Regional COVID-19 therapeutic guidelines were released that recommended against antibiotic use in patients with mild-to-moderate disease **Langford et al was published identifying a low rate of bacterial coinfection on admission.

Fig. 2.

Respiratory antibiotic use in intensive care units. *Regional COVID-19 therapeutic guidelines were released that recommended antibiotic use in critically ill patients when bacterial coinfection was suspected. **Langford et al was published identifying a low rate of bacterial coinfection on admission. ***Regional COVID-19 therapeutic guidelines were revised to highlight the low rate of bacterial coinfection on admission and recommended against antibiotic use in critically ill patients unless bacterial coinfection was strongly suspected.