Objective: 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. Design: Retrospective observational study. Setting: Tertiary-care academic medical center. Participants: Internal medicine and medical intensive care unit (MICU) provider teams and hospitalized COVID-19 patients. Methods: 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. Results: 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. Conclusions: 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.
【초록키워드】 COVID-19, therapy, intensive care, Intervention, antimicrobial, Characteristics, implementation, Patient, Care, Guidance, recommendations, antibiotic, Analysis, internal medicine, COVID-19 patient, Factor, hospitalized COVID-19 patients, 95% CI, Poisson regression, effective, decrease, multivariable, initial, performed, significantly, evaluated, changes in, reduce, expected, patients hospitalized, treating COVID-19 patient, with COVID-19, 【제목키워드】 COVID-19, coronavirus disease, pandemic, implementation, change, Guidance,