The Evolution of Empiric Antimicrobial Prescribing Patterns and Patient-Associated Antimicrobial Risk Factors over Time in COVID-19

ABSTRACT

Introduction: Despite low rates of bacterial co-infection in patients admitted with COVID-19, antibiotics are frequently prescribed in acute care settings. Antimicrobial stewardship program (ASP) efforts have evolved during the progression of the COVID-19 pandemic. We sought to evaluate the overall antimicrobial prescribing rate in patients with COVID-19, as well as assess changes to these patterns over time. Research Question or Hypothesis: What factors are associated with increased empiric antibiotic prescribing in COVID-19, and what is the impact of ASPs on prescribing rates? Study Design: Retrospective chart review of patients admit to a tertiary care center with symptomatic COVID-19 between March 1st, 2020 and November 30th, 2020. Methods: Symptomatic adults admitted with a positive SARS-CoV-2 polymerase chain reaction test were included for review and stratified by disease severity. Patient and provider demographics, antimicrobial utilization, and culture data were collected. Poisson regression was used to assess changes in antimicrobial prescribing over time. Logistic regression was used to assess factors associated with the empiric use of antimicrobial agents among patients without an existing positive bacterial respiratory culture. Results: 654 patients were included for review;189 with mild, 242 with moderate, and 223 with severe COVID-19. Antibiotics were prescribed in 37.9% of the cohort, with an increased incidence by disease severity (16.9% mild, 29.8% moderate, and 64.6% severe, p < 0.001). 85.1% of antibiotics administered were prescribed within 48 hours of hospital admission. Over the course of the study, antimicrobial prescribing rates decreased by 8.7% per month despite a concurrent increase in COVID-19 admissions. Multivariate analysis found that ICU admission, obtainment of procalcitonin, intubation, heart failure, hemodialysis, and nursing home residence were associated with empiric antimicrobial prescribing. Conclusion: ASPs should take an active role on intervening in unnecessary antimicrobial use targeting populations most at risk for unnecessary exposure. The application of ASP techniques appear to impact antimicrobial use trends even during the COVID-19 pandemic.