Becker's Clinical Quality & Infection Control

53 QUALITY IMPROVEMENT & MEASUREMENT Antibiotics significantly overprescribed during early months of pandemic, Pew study suggests By Erica Carbajal D espite few hospitalized COVID-19 patients having a bacterial infection, a majority of hospitalizations led to at least one antibiotic prescription, accord- ing to the Pew Charitable Trusts' Antibiotic Resistance Project published March 10. Researchers used electronic health records to evaluate the frequency of bacterial infec- tions and antibiotic prescribing patterns in COVID-19 patients hospitalized between Feb. 1, 2020, and July 31, 2020, and who were discharged by Sept. 7, 2020. e anal- ysis included 5,838 COVID-19 hospital ad- missions across the U.S., representing 4,980 patients, as some were admitted numerous times during the study period. Four findings: 1. Fiy-two percent of hospital admissions led to at least one antibiotic prescription, and 36 percent led to a patient being pre- scribed multiple antibiotics. 2. Overall, 20 percent of hospitalized COVID-19 patients were diagnosed with suspected or confirmed bacterial pneumo- nia, and 9 percent were diagnosed with a community-acquired urinary tract infection. 3. While it usually takes at least 48 hours to confirm a bacterial infection, in 96 percent of admissions that resulted in an antibiotic prescription, patients received the medication at the time of admission or within 48 hours. 4. Just 15 percent of admissions resulted in a patient receiving both an antibiotic within the first 48 hours and another course aer that, suggesting fewer antibiotics are prescribed as physicians gather more information. "Our data shows there was very likely a significant amount of unnecessary antibiotic prescribing among hospitalized COVID-19 patients," said Rachel Zetts, an officer with Pew's antibiotic resistance project and study co-author. Lack of guidance on treatment during earlier stages of the pandemic may have been a factor in the overuse of antibiotics, she added. "Overprescribing on this scale could neg- atively impact the progress we've made in the fight against antibiotic resistance over recent years, so encouraging physicians to reduce inappropriate antibiotic use and equipping them with the tools needed to do so is critical," Ms. Zetts told Becker's. "In the event of the next pandemic, having antibiotic stewardship programs in place not only helps improve patient care during the public health emergency itself, but it also helps preserve the effectiveness of existing antibiotics." n Nearly 50% of women get inappropriate antibiotic prescriptions for UTI, study finds By Erica Carbajal A bout half of women seeking treatment for uncomplicat- ed urinary tract infection receive inappropriate antibiotic prescriptions and 76 percent get prescriptions that are too long, according to a study published Feb. 24 in Infection Control Hospital Epidemiology. Researchers identified 670,450 U.S. women between the ages of 18 and 44 who received an outpatient UTI diagnosis from April 1, 2011, to June 30, 2015. The analysis is based on data from com- mercial insurance claims. They found 46.7 percent of women re- ceived inappropriate antibiotic prescriptions and 76.1 percent of prescriptions were inappropriately long. Women living in rural areas were also more likely to receive unnecessarily long prescription durations compared to those from urban areas, according to the findings published Feb. 24. "Antimicrobial stewardship interventions are needed to improve outpatient UTI antibiotic prescribing and to reduce unnecessary exposure to antibiotics, particularly in rural settings," the study authors said. n NYC Health + Hospitals aims to reduce unnecessary care with systemwide guidelines By Mackenzie Bean N YC Health + Hospitals has adopted systemwide guidelines to reduce un- necessary care and curb the spread of COVID-19 in its facilities, the New York City-based organization said March 16. The American Board of Internal Medicine devel- oped the COVID-19 "Choosing Wisely" guidelines, which also features recommendations on how best to use limited resources. The health system adopted five specific recom- mendations from the guidelines, including not or- dering routine chest X-rays for COVID-19 patients and reducing daily lab testing if a patient's clinical labs are stable. It selected the five guidelines after soliciting input from clinicians and safety officers in its organization. n

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