Stewardship / Resistance Scan for Nov 15, 2021

Antibiotic Rx in UK amid COVID
Appropriate antibiotic treatment for pneumonia

English study finds less antibiotic prescribing amid pandemic

Antibiotic prescribing in general practice in England fell significantly during the first 12 months of the COVID-19 pandemic compared with the previous year, according to data released last week by Antibiotic Research UK (ANTRUK).

Analysis of prescription data from the England's National Health Service showed that from March 2020 through February 2021, antibiotic prescribing by general practitioners (GPs) declined by 17% compared with the previous 12 months, and the decline occurred in almost all areas of the country. The analysis also found that the rise in antibiotic prescribing that typically occurs in the winter in England was considerably lower for the winter of 2020 to 2021.

While antibiotic prescribing has risen by 21% on average from the summer (June to August) to the winter (December to February) in previous years, antibiotic prescribing from December 2020 to February 2021 only rose by 4%.

"The dramatic fall in antibiotic prescribing during the COVID pandemic could be due to many factors including less infection transmission during lockdowns and fewer visits to GPs," ANTRUK Chief Executive Colin Garner, PhD, said in a press release.

"More work is needed to understand the extent to which each of these factors has resulted in this drop in antibiotic prescribing, but the data does tell us that antibiotic prescribing can be reduced to help protect us all from the danger of the growing threat of antibiotic resistance."
Nov 11 ANTRUK press release


Michigan hospital project tied to shorter antibiotic course for pneumonia

Participation in a prospective collaborative quality initiative (CQI) was associated with more appropriate use of short-course antibiotic therapy for pneumonia, according to a study published last week in Clinical Infectious Diseases.

The study looked at data from a 3-year project undertaken by 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium, a statewide collaborative quality initiative. The project targeted appropriate 5-day antibiotic treatment for uncomplicated community-acquired pneumonia (CAP), using benchmarking, sharing of best practices, and pay-for-performance metrics.

To evaluate the impact of the program, researchers assessed appropriate receipt of a 5-day antibiotic duration and 30-day post-discharge composite adverse events (mortality, readmission, urgent visit, antibiotic-associated adverse events) for patients with uncomplicated CAP.

Overall, 6,553 patients with uncomplicated CAP were eligible for 5-day treatment at the 41 hospitals from February 2017 through February 2021. Over the study period, the percentage of patients treated with a 5-day course of antibiotics rose from 22.1% to 45.9%. Each quarter was associated with higher odds of receiving an appropriate 5-day course of antibiotics (adjusted odds ratio, [aOR], 1.10; 95% confidence interval [CI], 1.07 to 1.14), for an annual aOR of 1.49 per year.

Thirty-day composite adverse events occurred in 18.5% of patients over the entire study period and decreased over time (aOR, 0.98 per quarter; 95% CI, 0.96 to 0.99) due mainly to a decrease in antibiotic-associated adverse events (aOR, 0.91; 95% CI, 0.87 to 0.95). Mortality, readmission, urgent visits, and Clostridioides difficile infections did not change over time.

The study authors suggest other states and healthcare systems should consider adopting this three-pronged method for improving antibiotic treatment.

"Participation in a stewardship CQI may not only improve antibiotic use, but also patient outcomes," the study authors wrote. "The observation that all hospitals, including small hospitals, benefited from CQI participation suggests that the CQI model could be one way to advance antibiotic stewardship even in small, rural hospitals with fewer resources."
Nov 13 Clin Infect Dis abstract

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