Antimicrobial Utilization Trends during the COVID-19 Pandemic Throughout the US

ABSTRACT

Introduction: The purpose of this study is to evaluate the trends of use of various antimicrobials prior to and during the coronavirus disease 2019 (COVID-19) pandemic, which is caused by a coronavirus and is unaffected by antimicrobials. Despite the inactivity of antimicrobials against COVID-19, they are still employed due the possibility of underlying or 'just in case' scenarios of bacterial infection. Research Question or Hypothesis: We hypothesis that the utilization rates of common intravenous antimicrobials correlate to the number of hospitalized COVID-19 patients. Study Design: Retrospective evaluation. Methods: This study utilized de-identified data and was exempt from requiring IRB approval. The antimicrobial utilization was collected through the National Center for Advancing Translational Sciences (NCATS) National COVID Cohort Collaborative (N3C) from 01/01/2019 to 12/31/2021. Antimicrobials of interest included carbapenems, 3rd/4th generation cephalosporins, fluoroquinolones, and piperacillin-tazobactam. Antimicrobial utilization rate was measured using the metric days of therapy (DOT) and patient days. Results: Ten antibiotics were evaluated in this study and accounted for 7,891,986 DOT over three years. Monthly antibiotic utilization (mean±SD per 10,000 patient days [PD]) in 2019 (28.3±13.9) was significantly higher than 2020 (10.8±1.5) and 2021 (12.1±5), p<0.001. All the antibiotics evaluated had significant decreases in utilization with the exception of ceftriaxone (CRO) and piperacillin-tazobactam (TZP). Monthly CRO utilization (mean±SD per 10,000 patient days) in 2019 (3.11±0.32) and 2020 (3.18±0.23) were similar, but higher than 2021 (2.88±0.29), p=0.16. TZP had a similar DOT/10,000PD trend where utilization in 2019 (2.1±0.39) and 2020 (1.8±0.09) were constant and higher than 2021 (1.61±0.08), p<0.001. There is a negative correlation between COVID-19 cases and antibiotics evaluated, r = -0.655, p<0.001. Conclusion: The antimicrobial utilization decreased during the years 2020-2021 with the exception of CRO and TZP. We plan to develop a model to determine the influence of COVID-19 on antibiotic prescribing and evaluate antimicrobial use based on US regions.