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

项目摘要/摘要 由严重急性呼吸系统综合症引起的持续流行的2019年冠状病毒病(新冠肺炎) 冠状病毒2(SARS-CoV-2)，已导致2600多万人感染，使医疗系统不堪重负 在整个美国，新冠肺炎的新颖性产生了前所未有的诊断和治疗 两难境地。一个新出现的令人担忧的领域是大流行对抗生素增加的间接影响 处方和相关的细菌耐药性加速。例如，早期的报告表明， 新冠肺炎患者接受抗生素治疗的比例很高，尽管几乎没有人确认 细菌混合感染。除了对公众健康的影响外，过度使用抗生素也是对 由于严重的药物不良事件和艰难梭状芽胞杆菌结肠炎的风险，患者的安全。2021年1月， 美国卫生保健流行病学学会发布了一份白皮书，概述了与以下相关的研究重点 新冠肺炎强调，迫切需要“确定医疗保健利用和利用变化的影响” 《提供抗生素处方》和《制定和实施最优抗菌药物管理计划》 (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 新冠肺炎期间送货。该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 全面表征新冠肺炎疫情对抗生素处方和细菌学的影响 急性护理医院的耐药性趋势，并确定有效推广弹性抗生素的策略 管家的职责。考虑到我们在评估方面的专业知识，组建的团队是唯一有资格实施这一项目的团队 抗生素处方模式，可获得约350家美国医院的数据，以及广泛的使用经验 分析管理干预的系统工程方法。对于定量分析，我们将首先 使用ANS描述新冠肺炎前后的整体和特定条件抗生素处方趋势 中断的时间序列分析。接下来，我们将确定患者和医院层面的因素，这些因素增加了 新冠肺炎大流行期间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下的定性分析，重点是 缓解新冠肺炎对抗生素处方影响最小和最有效的医院，以确定 系统层面的背景因素和战略。这些结果将用于多学科合作设计 开发抗生素管理实施工具包的过程，以增强运营期间的弹性 剧变，并可在不同组织之间转移。鉴于大流行的动态性质(例如变种 菌株)，当务之急是将抗生素处方以前、正在和未来的不良影响分类为 指导制定量身定做的管理战略，以便广泛传播。这部作品代表了一种 为人道协调厅持续努力抗击新冠肺炎和长期存在的猪流感大流行做出了重要贡献 抗菌素耐药性感染。

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.