COVID-19 and Antibiotic Prescribing in Pediatric Primary Care
COVID-19 and Antibiotic Prescribing in Pediatric Primary Care
复制标题
DOI：
10.1542/peds.2021-053079
复制
发表时间：
2022-02-01
期刊：
影响因子：
8
通讯作者：
Gerber, Jeffrey S. S.
中科院分区：
文献类型：
--
作者：
Dutcher, Lauren;Li, Yun;Gerber, Jeffrey S. S.
随着2019冠状病毒病（COVID-19）大流行的爆发，儿科门诊就诊量和抗生素处方量都有所下降;然而，美国儿科初级保健减少的持久性尚未得到评估。方法我们进行了一项回顾性观察研究，以评估COVID-19大流行和相关公共卫生措施对27个儿科初级保健实践中抗生素处方的影响。包括2018年1月1日至2021年6月30日的遭遇。主要结果是每1000名患者每月抗生素处方。进行中断时间序列分析。2019年4月至12月共有69327张抗生素处方，2020年同期有18935张抗生素处方，减少了72.7%。呼吸道感染（RTI）访视时处方的减少占这一减少的87.3%。使用中断时间序列分析，2020年4月，总体抗生素处方从每1000例患者31.6张降至6.4张（差异为每1000例患者-25.2张处方; 95%CI：-32.9至-17.5）。其次是抗生素处方的月度增长并不显著，处方量从2021年4月至6月开始反弹。遭遇数量也立即下降，虽然整体遭遇数量迅速开始恢复，但RTI遭遇数量恢复得更慢。结论在COVID-19大流行期间，儿科初级保健中抗生素处方的减少持续，仅在2021年开始上升，主要是由于RTI遭遇的减少。病毒性RTI传播的减少可能在减少RTI就诊和抗生素处方方面发挥了重要作用。
BACKGROUND AND OBJECTIVESWith the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric ambulatory encounter volume and antibiotic prescribing both decreased; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. METHODSWe conducted a retrospective observational study to assess the impact of the COVID-19 pandemic and associated public health measures on antibiotic prescribing in 27 pediatric primary care practices. Encounters from January 1, 2018, through June 30, 2021, were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients. Interrupted time series analysis was performed. RESULTSThere were 69 327 total antibiotic prescriptions from April through December in 2019 and 18 935 antibiotic prescriptions during the same months in 2020, a 72.7% reduction. The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease. Using interrupted time series analysis, overall antibiotic prescriptions decreased from 31.6 to 6.4 prescriptions per 1000 patients in April 2020 (difference of -25.2 prescriptions per 1000 patients; 95% CI: -32.9 to -17.5). This was followed by a nonsignificant monthly increase in antibiotic prescriptions, with prescribing beginning to rebound from April to June 2021. Encounter volume also immediately decreased, and while overall encounter volume quickly started to recover, RTI encounter volume returned more slowly. CONCLUSIONSReductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained, only beginning to rise in 2021, primarily driven by reductions in RTI encounters. Reductions in viral RTI transmission likely played a substantial role in reduced RTI visits and antibiotic prescriptions.