Abstract
Abstract Background Significant concerns have been raised regarding the overuse of antibiotics among patients hospitalized for COVID-19 and the broad impact of the pandemic on antimicrobial stewardship in acute care. We sought to compare potentially unnecessary antibiotic prescribing over time among patients admitted with symptomatic COVID-19 and non-COVID-19 viral acute respiratory tract infections (ARTIs). Methods We conducted a repeated cross-sectional analysis of the monthly antibiotic prescribing rate from March 2020 to December 2023 for COVID-19 admissions and January 2019 to December 2023 for other viral ARTI admissions to 803 acute care hospitals in the US that contributed data to the Premier Healthcare Database (PHD). Our primary outcome was the receipt of at least one dose of an antibiotic during the first five days of admission. Secondary outcomes included days and duration of antibiotic therapy. Results This study included 513,698 COVID-19 and 106,932 non-COVID-19 viral ARTI admissions for March 2020 to December 2023. At the onset of the pandemic, over 80% of patients admitted for COVID-19 received antibiotics and antibiotic prescribing for other viral ARTIs increased to nearly 70%. Antibiotic prescribing for these viral infections declined over time with prescribing for COVID-19 stabilizing around 35% in 2022-23 and prescribing for other viral ARTIs returning to 2019 seasonal patterns in 2023 with average monthly prescribing around 50%. Conclusion Despite improvements since the early part of the COVID-19 pandemic, potentially unnecessary antibiotic prescribing for inpatients with COVID-19 and non-COVID-19 viral ARTIs remains an important antibiotic stewardship target.
Published Version
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