Antimicrobial Stewardship Education Reduces Antibiotic Prescriptions in COVID-19 Patients

As healthcare workers prioritized treating COVID-19 patients, antibiotic use increased and antimicrobial stewardship practices were somewhat neglected. One study, presented at this week’s Society for Healthcare Epidemiology of America Conference 2022 (SHEA), evaluated community acquired pneumonia (CAP) specific antibiotics after successful utilization in COVID-19 patients.

The study was conducted at the Veterans Affairs Maryland Healthcare System and evaluated the use of common CAP antibiotics at pre and post periods during the COVID-19 pandemic. Antibiotics examined were ceftriaxone IV/IM, cefpodoxime PO, azithromycin PO/IV, ampicillin/sulbactam IV, amoxicillin-clavulanate PO, and levofloxacin.

In the pre-evaluation, from April-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.

In the post period, from November 2020-April 2021, additional interventions were added: weekly informational COVID-19 virtual seminars for healthcare providers, and targeted education for emergency department and hospital directors.

The investigators compared antibiotic prescriptions during the pr and post periods using Χ2 statistic, stratified by location. They analyzed the rate 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 acute care center, 8.1% (n=66) were long-term care residents, and 69.5% (n=566) were treated out of 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 decreased 9%; there were 86/273 CAP antibiotics prescribed to COVID-19 patients in the post period, as compared to 125/541 antibiotics prescriptions in the pre period. This decrease was observed in all locations; acute care decreased from 57% to 44%, long term care from 53% to 41%, and outpatient from 19% to 15%.

From the pre to post periods, the rate of CAP antibiotic prescribing decrease by 70 per 100 COVID-19 patients. The results, presented by lead author Ravi Tripathi, MD, led the investigators to conclude that the multi-faceted educational approach led to significant decreases in antibiotic prescribing, even as COVID-19 cases continued to rise.

The study, “A Little Education Goes a Long Way: Decreasing Antibiotics for Community-acquired Pneumonia in COVID-19 Patients,” was presented on April 12 during the Society for Healthcare Epidemiology of America Conference 2022 (SHEA).