Changes in Antimicrobial Utilization During the COVID-19 Pandemic after Implementation of a Multispecialty Clinical Guidance Team

OBJECTIVE: Evaluate changes in antimicrobial use (AU) during COVID-19 and after implementation of a multispecialty COVID-19 clinical guidance team compared to pre-COVID-19 AU DESIGN: Retrospective observational study SETTING: Tertiary academic medical center PARTICIPANTS: Internal Medicine (IM) and medical intensive care unit (MICU) provider teams and hospitalized COVID-19 patients METHODS: Difference-in-differences analyses of antibiotic days of therapy per 1000 patient days present (DOT) for IM and MICU teams treating COVID-19 patients versus teams that did not were performed for three periods: pre-COVID19, initial COVID-19 period, and after implementation of a multispecialty COVID-19 clinical guidance team which included daily, patient-specific antimicrobial stewardship recommendations Patient characteristics associated with antibiotic DOT were evaluated by multivariable Poisson regression RESULTS: In the initial COVID-19 period, compared to the pre-COVID-19 period, IM and MICU teams increased weekly AU by 145 3 [95% CI 35 1 to 255 5] and 204 0 [95% CI -16 9 to 424 8] DOT, respectively compared to non COVID-19 teams In the intervention period, IM and MICU COVID-19 teams both had significant weekly decreases of 362 3 [95% CI -443 3 to -281 2] and 226 3 [95% CI -381 2 to -71 3] DOT Of 131 patients hospitalized with COVID-19, 86 (65 6%) received antibiotics;no specific patient factors were significantly associated with expected antibiotic DOT CONCLUSIONS: AU initially increased for COVID-19 patient care teams compared to pre-COVID-19 levels, but significantly decreased after implementation of a multispecialty clinical guidance team, which may be an effective strategy to reduce unnecessary AU