Changes in antimicrobial utilization during the coronavirus disease 2019 (COVID-19) pandemic after implementation of a multispecialty clinical guidance team.

Milner B Staub,Ronald M Beaulieu,George E Nelson,John Graves

doi:10.1017/ice.2020.1291

Abstract

Evaluate changes in antimicrobial use during COVID-19 and after implementation of a multispecialty COVID-19 clinical guidance team compared to pre-COVID-19 antimicrobial use. Retrospective observational study. Tertiary-care academic medical center. Internal medicine and medical intensive care unit (MICU) provider teams and hospitalized COVID-19 patients. Difference-in-differences analyses of antibiotic days of therapy per 1,000 patient days present (DOT) for internal medicine and MICU teams treating COVID-19 patients versus teams that did not were performed for 3 periods: before COVID-19, initial COVID-19 period, and after implementation of a multispecialty COVID-19 clinical guidance team which included daily, patient-specific antimicrobial stewardship recommendations. Patient characteristics associated with antibiotic DOT were evaluated using multivariable Poisson regression. In the initial COVID-19 period, compared to the pre-COVID-19 period, internal medicine and MICU teams increased weekly antimicrobial use by 145.3 DOT (95% CI, 35.1-255.5) and 204.0 DOT (95% CI, -16.9 to 424.8), respectively, compared to non-COVID-19 teams. In the intervention period, internal medicine and MICU COVID-19 teams both had significant weekly decreases of 362.3 DOT (95% CI, -443.3 to -281.2) and 226.3 DOT (95% CI, -381.2 to -71.3). Of 131 patients hospitalized with COVID-19, 86 (65.6%) received antibiotics; no specific patient factors were significantly associated with an expected change in antibiotic days. Antimicrobial use initially increased for COVID-19 patient care teams compared to pre-COVID-19 levels but significantly decreased after implementation of a multispecialty clinical guidance team, which may be an effective strategy to reduce unnecessary antimicrobial use.

Highlights

Using a differences-in-differences (DiD) design in this retrospective study of COVID-19 patients hospitalized from March 1 through May 15, 2020, we aimed to evaluate how antimicrobial use among internal medicine and medical intensive care unit (MICU) provider teams changed before and after the COVID-19 pandemic and whether implementation of a multispecialty COVID-19 clinical guidance team (“COVID-19 huddle”) that included antimicrobial stewardsip recommendations influenced antimicrobial use
Team-based antibiotic use Compared to the pre–COVID-19 period, internal medicine COVID-19 teams had an initial increase in weekly antimicrobial use of 145.3 DOT per 1,000 days in the first post–COVID-19 period when compared to non–COVID-19 internal medicine teams, adjusted for individual team and week (Fig. 1)
This increase was followed by a significant reduction in weekly antimicrobial use of 226.3 antibiotic DOT per 1,000 days from pre–COVID-19 antimicrobial use for COVID-19 compared to non–COVID-19 MICU teams after implementation of the COVID-19 huddle (Fig. 2)

Summary

Introduction

Using a differences-in-differences (DiD) design in this retrospective study of COVID-19 patients hospitalized from March 1 through May 15, 2020, we aimed to evaluate how antimicrobial use among internal medicine and medical intensive care unit (MICU) provider teams changed before and after the COVID-19 pandemic and whether implementation of a multispecialty COVID-19 clinical guidance team (“COVID-19 huddle”) that included antimicrobial stewardsip recommendations influenced antimicrobial use. This increase was followed by a significant reduction in weekly antimicrobial use of 226.3 antibiotic DOT per 1,000 days (95% CI, −381.2 to −71.3) from pre–COVID-19 antimicrobial use for COVID-19 compared to non–COVID-19 MICU teams after implementation of the COVID-19 huddle (Fig. 2).

Results

Conclusion