As healthcare professionals prioritized treating COVID-19 patients, antibiotic use increased and antimicrobial administration practice was a bit neglected. A study, presented this week Society for Healthcare Epidemiology of America Conference 2022 (SHEA), community-acquired pneumonia (CAP) evaluated specific antibiotics after successful use in COVID-19 patients.
The study was conducted by the Veterans Affairs Maryland Healthcare System and evaluated the use of common CAP antibiotics before and after periods during the COVID-19 pandemic. Antibiotics tested were ceftriaxone IV / IM, cefpodoxime PO, azithromycin PO / IV, ampicillin / sulbactam IV, amoxicillin clavulanate PO and levofloxacin.
In the pre-evaluation, from April to October 2020, the following interventions were implemented by antimicrobial stewardship experts: inpatient weekly virtual interdisciplinary COVID-19 rounds, procalcitonin in clinical decision making and inpatient audit and feedback of active antibiotics.
During the post period, from November 2020-April 2021, additional interventions were added: weekly informative COVID-19 virtual seminars for healthcare providers and targeted training for emergency departments and hospital directors.
The researchers compared antibiotic prescriptions during the PR and post periods using Χ2 statistics, stratified by location. They analyzed the number of CAP antibiotics prescribed per 100 COVID-19 patients using Poisson distribution.
A total of 814 COVID-19 patients were included in the study. Among them, 22.4% (n = 182) were admitted to the emergency center, 8.1% (n = 66) were long-term caregivers, and 69.5% (n = 566) were treated outside the hospital. A total of 25% of the 814 COVID-19 patients (n = 211) were prescribed a CAP antibiotic. Of the antibiotics prescribed, 61% (n = 223) were either ceftriaxone, cefpodoxime, amoxicillin clavulanate or ampicillin sulbactam, 34% (n = 123) were azithromycin, and 4.4% (n = 16) were levofloxacin.
After the post-interventions were implemented, antibiotic prescriptions fell by 9%; 86/273 CAP antibiotics were prescribed to COVID-19 patients in the postoperative period compared to 125/541 antibiotic prescriptions in the pre-period. This decline was observed everywhere; emergency care fell from 57% to 44%, long-term care from 53% to 41% and outpatient care from 19% to 15%.
From the pre- to post-period, the frequency of CAP antibiotic prescribing decreases by 70 per 100 COVID-19 patients. The results, presented by lead author Ravi Tripathi, MD, led investigators to conclude that the multifaceted pedagogical approach led to significant decreases in antibiotic prescribing, although COVID-19 cases continued to increase.
The study, “A Little Education Goes a Long Way: Reducing Antibiotics for Community-Acquired Pneumonia in COVID-19 Patients,” was presented on April 12 during Society for Healthcare Epidemiology of America Conference 2022 (SHEA).