Characterizing the ImPact of COVID-19 on Antibiotic PreScribing in AcutE Care and IDentifying Resilient Stewardship Strategies (POISED)

项目概要/摘要 由严重急性呼吸系统综合征引起的2019冠状病毒病（COVID-19）大流行正在持续 冠状病毒2（SARS-CoV-2）已导致超过2600万例感染，并使医疗保健系统不堪重负 COVID-19的新特性产生了前所未有的诊断和治疗方法。 进退两难一个新出现的关注领域是大流行对抗生素增加的附带影响 处方和相关的细菌耐药性加速。例如，早期的报告表明， 高比例的COVID-19住院患者接受抗生素治疗，尽管很少有人证实 细菌合并感染。除了对公共卫生的影响，过度使用抗生素也是一种威胁， 由于严重药物不良事件和艰难梭菌结肠炎的风险，患者安全性。2021年1月， 美国卫生保健流行病学协会发布了一份白色文件，概述了与以下方面有关的研究优先事项： COVID-19强调迫切需要“确定医疗保健利用变化的影响， 提供抗生素处方”和“制定和实施最佳的抗菌药物管理计划 (ASP)在适应不断变化的医疗保健的同时改善抗菌药物使用和患者结局的战略 在COVID-19期间交付”。这个项目是专门为响应这一行动呼吁而设计的，因为我们的目标是 全面描述COVID-19大流行对抗生素处方和细菌感染的影响， 急性护理医院的耐药性趋势，并确定有效促进弹性抗生素的策略 管理工作鉴于我们在评估方面的专业知识，组装团队是唯一有资格进行此项目的 抗生素处方模式，获得来自约350家美国医院的数据以及使用抗生素的广泛经验 系统工程方法来分析管理干预。对于定量分析，我们将首先 在COVID-19之前和之后，使用 中断时间序列分析接下来，我们将确定患者和医院水平的因素，增加了风险， COVID-19大流行期间的非适应症抗生素处方，目的是确定潜在的 干预目标。最后，我们将完成一个系统工程指导的定性分析，重点是 最少和最有效地减轻COVID-19对抗生素处方影响的医院，以确定 系统层面的背景因素和策略。这些结果将用于多学科协同设计 开发抗生素管理实施工具包的过程，该工具包可增强操作期间的弹性 在组织之间转移。鉴于流行病的动态性质（例如变异 菌株），必须对抗生素处方的既往、持续和未来不良影响进行分类， 指导制定有针对性的管理战略，以便广泛传播。这项工作代表了一个 为AHRQ持续抗击COVID-19和长期流行的 抗微生物感染。

Project Summary/Abstract The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in over 26 million infections and overwhelmed healthcare systems throughout the U.S. The novel nature of COVID-19 has generated unprecedented diagnostic and therapeutic dilemmas. One area of emerging concern is the collateral impact of the pandemic on increased antibiotic prescribing and an associated acceleration of bacterial resistance. For instance, early reports indicate that a high percentage of patients hospitalized with COVID-19 receive antibiotics despite few having confirmed bacterial co-infections. In addition to the public health implications, overuse of antibiotics is also a threat to patient safety due to the risk of serious adverse drug events and Clostridioides difficile colitis. In January 2021, the Society for Healthcare Epidemiology of America issued a white paper outlining research priorities related to COVID-19 that highlighted an urgent need to “identify the impact of changes in health care utilization and delivery on antibiotic prescribing” and “develop and implement optimal Antimicrobial Stewardship Program (ASP) strategies to improve antimicrobial use and patient outcomes while adapting to changing healthcare delivery during COVID-19”. This project is specifically designed to address this call to action as we aim to comprehensively characterize the impact of the COVID-19 pandemic on antibiotic prescribing and bacterial resistance trends in acute care hospitals and identify strategies that effectively promote resilient antibiotic stewardship. The assembled team is uniquely qualified to conduct this project given our expertise in evaluating antibiotic prescribing patterns, access to data from ~350 U.S. hospitals and extensive experience using systems engineering methods to analyze stewardship interventions. For the quantitative analyses, we will first characterize overall and condition specific antibiotic prescribing trends before and after COVID-19 using an interrupted time series analysis. Next, we will identify patient and hospital level factors that increased the risk of non-indicated antibiotic prescribing during the COVID-19 pandemic, with the goal of identifying potential intervention targets. Finally, we will complete a systems engineering guided qualitative analysis, focused on hospitals that least and most effectively mitigated the impact of COVID-19 on antibiotic prescribing, to identify systems-level contextual factors and strategies. These results will be used in a multidisciplinary co-design process to develop an antibiotic stewardship implementation toolkit that enhances resiliency during operational upheaval and is transferable between organizations. Given the dynamic nature of the pandemic (e.g. variant strains), it is imperative to classify the previous, ongoing and future adverse impacts on antibiotic prescribing to guide development of tailored stewardship strategies for widespread dissemination. This work represents a vital contribution to AHRQ’s ongoing efforts to combat both COVID-19 and the longstanding pandemic of antimicrobial-resistant infections.