ABSTRACT
Background. Several countries in Latin America reported an increase in antibiotic use during the first wave of the COVID-19 Pandemic. Methods. We retrospectively evaluated antibiotic use among 10,752 members of a private healthcare system in Santa Cruz de la Sierra, Bolivia, between Jan-Dec 2019 (pre-pandemic) and Jan-Aug 2020 (pandemic). Antibiotic use was calculated as daily defined doses (DDD) per 1,000 member-days, per 100 ambulatory visits, and per 100 inpatient-days, and categorized using the World Health Organization classification (Access, Watch, and Reserve), based on the impact of different antibiotics on antimicrobial resistance. In April 2020, the antibiotic stewardship team developed COVID-19 treatment guidelines for ambulatory and hospitalized patients and provided recommendations on all patients hospitalized due to COVID-19. Due to the nature of the network, guideline use is usually high. During the pandemic period and due to local restrictions, patient interactions were mostly limited to COVID-19 presentations. Differences with 95% confidence intervals (CI) between groups were estimated. Results. Pandemic and pre-pandemic antibiotic use in DDD/1,000 member-days was 8.48 and 18.37, respectively (diff. -8.89, 95%CI -10.11 to -9.67). Outpatient DDD/100 ambulatory visits was 67.68 vs. 86.20 (diff. -18.52, 95%CI -19.94 to - 17.1), and hospital DDD/per 100 inpatient-days was 39.79 vs. 61.71 (diff. -21.92, 95%CI -26.2 to -17.68) for pandemic and pre-pandemic periods, respectively. During the pandemic period, an overall reduction in macrolides use was also observed (-3.13 DDD/100 ambulatory visits, 95%CI -3.84 to -2.44, and -2.05 DDD/per 100 inpatient-days, 95%CI -2.88 to -1.26). Additionally, an increase in Access antimicrobials (83.3% vs. 79.5%;diff. 3.8%, 95%CI 0.3% to 7.4%) and a reduction in the Watch group (16.7% vs. 20.5%;diff. -3.7%, 95%CI -7.4% to -0.1%) were observed for pandemic and pre-pandemic periods, respectively. Conclusion. In this closed network, we observed a reduction in antibiotic use both in ambulatory and inpatient settings. Although, multifactorial, we believe the enhanced antibiotic stewardship approach on COVID-19 patients played a role in limiting antimicrobial use in this private healthcare system.