Infectious Disease

Antibiotic use declined among people hospitalized with COVID-19 from 2020 to 2022

Evan Vega November 2, 2023

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November 01, 2023

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Key takeaways:

Antibiotic use for patients hospitalized with COVID-19 declined from 71.1% in 2020 to 62.1% in 2022.
The largest decreases were seen for azithromycin and ceftriaxone.

Antibiotic use among critically ill patients hospitalized with COVID-19 declined between 2020 and 2022, researchers found.

“Antibiotics are commonly prescribed to patients who have COVID -19 even though they do not treat viral infections,” Christine Kim, PhD, MSPH, senior health scientist at CDC, told Healio.

Antibiotics Adobe Stock

Antibiotic use for patients hospitalized with COVID-19 declined between 2020 and 2022, with the largest decreases among azithromycin and ceftriaxone. Image: Adobe Stock.

“We updated a previous analysis of hospital discharge records in PINC AI Healthcare Data through June 2022 to characterize inpatient antibiotic use in patients hospitalized with COVID-19. The main objective of this analysis was to evaluate changes in antibiotic use and identify opportunities for improving prescribing practices,” she said.

To do so, Kim and colleagues conducted a retrospective analysis of adults aged 18 years and older who were hospitalized in the U.S. and included in the PINC AI Healthcare Data (PHD) Special Release COVID-19 edition (PHD-SR COVID-19) — a hospital-based, all-payer database that contains inpatient discharge records from participating general acute-care, nonfederal U.S. hospitals.

Researchers used this cohort to calculate the monthly proportion of hospital discharges in which patients received at least one dose of an antibiotic during their hospital stay and stratified by critical care status, days of therapy (DOT)/1,000 patient days (PDs) and length of therapy/1000 PDs, according to the study.

In total, 1,142,752 adults were hospitalized and discharged with a COVID-19 diagnosis between March 2020 and June 2022, with most patients (69.9%) receiving an antibiotic during their hospital stay — 88.1% of which were started at admission.

According to the study, antibiotic use rates were higher among critically ill patients compared with those among noncritically ill patients (903 DOT/1,000 PDs vs. 763 DOT/1,000 PDs). These patients were more likely to be older, critically ill, have longer hospital stays and higher in-hospital mortality.

Overall, the study showed that among noncritically ill patients discharged in 2020, 71.1% received an antibiotic — of whom 92.3% were started on admission — vs. 62.1% in 2022, of whom 88.2% were started on admission. The largest decreases in antibiotics were observed for azithromycin (40.2% to 30.9%) and ceftriaxone (46.6% to 39.9%).

“Hospital antimicrobial stewardship programs are critical in leading efforts to decrease early initiation of unnecessary antibiotics among patients hospitalized with COVID-19,” Kim said. “With increasing cases of respiratory viruses this season, stewardship programs also support optimizing the use of diagnostic testing and appropriate antimicrobial treatment, including antiviral therapy, to improve the evaluation and treatment of patients hospitalized with respiratory infections.”

Kim added, “Clinicians should follow national or hospital treatment guidelines for patients with COVID-19.”

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