Antibiotic use in US hospitals increased during COVID-19 waves
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Key takeaways:
- Inpatient antimicrobial use increased approximately 7% in April 2020 compared with April 2019.
- Increased use of azithromycin, ceftriaxone, and piperacillin with tazobactam were observed during COVID-19 waves.
Inpatient antimicrobial use in U.S. hospitals increased both overall and among specific commonly used antibiotics during peak waves of the COVID-19 pandemic, researchers reported.
“With many hospitals voluntarily reporting inpatient antimicrobial use data to the CDC’s [National Healthcare Safety Network (NHSN)], we were well positioned to analyze how national rates of administration of certain antibiotics tracked with national COVID-19 infection waves,” Melinda Neuhauser, PharmD, MPH, pharmacist and acute-care lead in the CDC’s Office of Antibiotic Stewardship, told Healio. “This information is important in support of our efforts to help improve antibiotic use in hospitals.”
Neuhauser and colleagues conducted a retrospective analysis of facilitywide inpatient antimicrobial use reported by acute-care hospitals to the NHSN Antimicrobial Use (AU) Option between January 2019 and July 2022.
According to the study, the researchers analyzed data on antibiotics administered via oral, parenteral, inhaled and intramuscular routes and calculated monthly pooled mean rates as antimicrobial days of therapy per 1,000 days present for all antibiotics reported to the AU Option during the study period. Additionally, they summed the number of new daily cases of COVID-19 in the U.S. as reported by CDC to the month level to highlight changes in COVID-19 case counts during the study period.
In total, the final analysis included data from 553 acute-care hospitals. Overall, the study showed that total antimicrobial use in April 2020 increased by 7%, whereas azithromycin increased by 64%, ceftriaxone by 27% and piperacillin with tazobactam by 5% compared with rates recorded in April 2019.
The study also showed that rates of azithromycin and ceftriaxone use increased in correlation with each rise in COVID-19 cases reported, with larger increases observed in November and December of 2020 and 2021 — although they noted that these increases were smaller than those seen in April 2020.
Rates of piperacillin with tazobactam also increased in December 2021. However, the researchers explained these increases were less pronounced than those reported with ceftriaxone and azithromycin.
“Studies published as early as 2020 showed that bacterial coinfections in hospitalized patients were uncommon at the time of presentation, and guidelines emphasized that antibiotics were not indicated for patients without evidence of bacterial coinfections,” Neuhauser said. “The finding that the magnitudes of antibiotic use increases were lower in subsequent COVID-19 waves indicates that hospitals were making progress toward improving antibiotic use.”
She added, “In the upcoming respiratory season, hospital antibiotic stewardship programs will play a critical role in optimizing diagnostic testing and treatment of patients with community-onset respiratory tract infections.”
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