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症引起的 2019 年冠状病毒病 (COVID-19) 持续大流行 冠状病毒 2 (SARS-CoV-2) 已导致超过 2600 万人感染，医疗系统不堪重负 在美国各地，COVID-19 的新颖性催生了前所未有的诊断和治疗 困境。新出现的一个令人担忧的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，早期报告表明 尽管很少有人确诊，但住院的 COVID-19 患者中接受抗生素治疗的比例很高 细菌合并感染。除了对公共卫生的影响外，抗生素的过度使用也对人类健康构成威胁。 由于存在严重药物不良事件和艰难梭菌结肠炎的风险，患者安全。 2021 年 1 月， 美国医疗保健流行病学协会发布了一份白皮书，概述了与以下方面相关的研究重点： COVID-19 强调迫切需要“确定医疗保健利用变化的影响和 提供抗生素处方”和“制定和实施最佳抗菌药物管理计划” (ASP) 改善抗菌药物使用和患者治疗结果同时适应不断变化的医疗保健的策略 COVID-19 期间的交付”。该项目是专门为响应这一行动号召而设计的，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的影响 急症护理医院的耐药趋势，并确定有效促进弹性抗生素的策略 管理权。鉴于我们在评估方面的专业知识，组建的团队具有执行该项目的独特资格 抗生素处方模式、可访问约 350 家美国医院的数据以及丰富的使用经验 分析管理干预的系统工程方法。对于定量分析，我们首先 使用以下方法描述 COVID-19 前后的整体和特定情况抗生素处方趋势 中断时间序列分析。接下来，我们将确定增加风险的患者和医院层面的因素 COVID-19 大流行期间的非指定抗生素处方，目的是确定潜在的抗生素 干预目标。最后，我们将完成系统工程引导的定性分析，重点是 减轻 COVID-19 对抗生素处方影响最小和最有效的医院，以确定 系统级背景因素和策略。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流程，以增强运营期间的弹性 剧变并且可以在组织之间转移。鉴于大流行的动态性质（例如变异 菌株），必须对抗生素处方的先前、当前和未来的不利影响进行分类 指导制定量身定制的管理策略以进行广泛传播。这部作品代表了一个 对 AHRQ 抗击新冠肺炎 (COVID-19) 和长期流行病的持续努力做出了重要贡献 抗菌药物耐药性感染。

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.