Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic
Abstract
:1. Introduction
- (1)
- To evaluate AMS implementation between PP and DP periods using the SSTF toolkit;
- (2)
- To determine the prevalence of inappropriately prescribed antibiotics PP and DP;
- (3)
- To identify factors influencing antibiotic prescribing and AMS implementation both PP and DP.
2. Materials and Methods
2.1. Study Design and Setting
2.2. Participants
2.3. Data Sources and Variables
2.4. Statistical Methods
3. Results
3.1. Clinical and Demographic Characteristics
3.2. Antibiotic Prescription ‘Start Smart’ Approach
3.3. Antibiotic Prescription: ‘Then Focus’ Approach
3.4. Antimicrobial Stewardship Implementation
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Characteristics | Prior to the Pandemic—2019 n (%) | During the Pandemic—2020 n (%) | p-Value | |
---|---|---|---|---|
Age (Range = 25–99) | Mean (SD) | 74.3 (16.0) | 76.2 (15.5) | 0.127 |
Gender | Female (%) | 158 (49.4) | 159 (49.7) | |
Male (%) | 162 (50.6) | 161 (50.3) | ||
Patient Outcome | Deceased (%) | 48 (15.0) | 50 (15.4) | 0.886 |
Discharged (%) | 272 (85.0) | 270 (84.4) | ||
LOS * (Range = 1–119) | Mean (SD) | 13.7 (13.7) | 13.1 (12.3) | 0.525 |
Prior to Pandemic—2019 n (%) | During the Pandemic—2020 n (%) | Adjusted OR (95% CI) | ||
---|---|---|---|---|
Age | 25–45 | 22 (6.9) | 22 (6.9) | - |
46–65 | 52 (16.3) | 46 (14.4) | 1.13 (0.49–2.68, p = 0.775) | |
66–85 | 156 (48.8) | 148 (46.3) | 1.35 (0.62–3.04, p = 0.455) | |
>85 | 90 (28.0) | 104 (32.4) | 1.75 (0.77–4.08, p = 0.186) | |
Gender | Female | 158 (49.4) | 161 (50.3) | - |
Male | 162 (50.6) | 159 (49.7) | 0.98 (0.67–1.42, p = 0.910) | |
Allergy | Allergy | 18 (5.6) | 17 (5.3) | - |
No Allergy | 254 (79.4) | 258 (80.6) | 1.00 (0.46–2.20, p = 1.000) | |
Not Documented | 46 (14.4) | 29 (9.1) | 0.58 (0.23–1.45, p = 0.243) | |
Side Effects | 2 (0.6) | 16 (5.0) | 7.23 (1.54–53.37, p = 0.023) * | |
Indication | CAP | 126 (39.4) | 136 (42.5) | - |
COPD | 30 (9.4) | 14 (4.4) | 0.42 (0.19–0.90, p = 0.029) * | |
HAP | 67 (20.9) | 52 (16.2) | 0.74 (0.46–1.20, p = 0.221) | |
VAP | 5 (1.5) | 1 (0.3) | 0.20 (0.01–1.38, p = 0.156) | |
URTI | 6 (1.9) | 8 (2.5) | 1.61 (0.46–5.85, p = 0.455) | |
LRTI | 30 (9.4) | 23 (7.2) | 0.77 (0.39–1.51, p = 0.452) | |
Pneumonia | 56 (17.5) | 42 (13.1) | 0.92 (0.53–1.60, p = 0.769) | |
COVID-19 Pneumonia | - | 44 (13.8) | 20.24 (5.82–128.19, p < 0.001) *** | |
Comorbidities | Hypertension | 143 (44.7) | 148 (46.2) | 1.17 (0.80–1.72, p = 0.414) |
Hypotension | 13 (4.0) | 14 (4.4) | 1.20 (0.49–2.91, p = 0.689) | |
Atrial Fibrillation | 61 (19.0) | 64 (20.0) | 1.02 (0.64–1.63, p = 0.922) | |
Heart Failure | 32 (10.0) | 63 (19.6) | 2.06 (1.23–3.52, p = 0.007) ** | |
Hypercholesteremia | 40 (12.5) | 58 (18.1) | 1.90 (1.14–3.20, p = 0.014) * | |
Diabetes Mellitus | 65 (20.3) | 54 (16.9) | 0.76 (0.47–1.22, p = 0.256) | |
Hypothyroidism | 24 (7.5) | 20 (6.2) | 0.81 (0.40–1.63, p = 0.555) | |
Kidney Diseases | 75 (23.4) | 46 (14.4) | 0.52 (0.32–0.84, p = 0.008) ** | |
Liver Diseases | 8 (2.5) | 19 (5.9) | 3.55 (1.41–9.82, p = 0.010) * | |
Malignancy | 50 (15.6) | 43 (13.4) | 0.95 (0.57–1.57, p = 0.850) | |
Osteoarthritis | 31 (9.7) | 40 (12.5) | 1.06 (0.58–1.93, p = 0.843) | |
Asthma | 35 (10.9) | 21 (6.5) | 0.50 (0.25–0.95, p = 0.038) * | |
COPD | 42 (13.1) | 40 (12.5) | 1.38 (0.76–2.49, p = 0.289) | |
Dementia | 25 (7.8) | 23 (7.2) | 0.81 (0.41–1.59, p = 0.538) | |
Epilepsy | 10 (3.1) | 13 (4.1) | 1.32 (0.49–3.65, p = 0.580) | |
Depression | 12 (3.7) | 20 (6.2) | 1.81 (0.77–4.39, p = 0.178) | |
Duration | ≤3 Days (Shorter) | 168 (52.5) | 164 (51.3) | - |
≥6 Days (longer) | 152 (47.5) | 156 (48.7) | 1.16 (0.82–1.66, p = 0.400) |
Prior to Pandemic—2019 n (%) | During the Pandemic—2020 n (%) | Adjusted OR (95% CI) | ||
---|---|---|---|---|
WBCs | 12 (3.8) | 11 (3.4) | ||
CRP | 82 (25.6) | 78 (24.4) | 1.00 (1.00–1.00, p = 0.595) | |
Serum Creatinine | 126 (39.4) | 123 (38.4) | 1.00 (1.00–1.00, p = 0.860) | |
Chest X-rays | Pneumonia % | 39 (12.2) | 54 (16.9) | 1.75 (1.04–2.97, p = 0.037) * |
No Pneumonia % | 82 (25.6) | 65 (20.3) | - | |
Not taken % | 199 (62.2) | 201 (62.8) | 1.26 (0.86–1.85, p = 0.231) | |
Day of Antibiotic Review | Mean (SD) | 4.2 (2.8) | 4.4 (2.9) | 1.02 (0.97–1.08, p = 0.461) |
Type of AMS Intervention | Change Antibiotics (Substitution) | 25 (7.8) | 20 (6.3) | - |
Continue Antibiotics | 14 (4.4) | 19 (5.9) | 3.36 (1.30–9.25, p = 0.015) * | |
De-escalation | 37 (11.6) | 81 (25.3) | 2.77 (1.37–5.70, p = 0.005) ** | |
Escalation | 65 (20.3) | 76 (23.8) | 1.50 (0.76–2.99, p = 0.248) | |
IV-to-Oral Switch | 70 (21.9) | 58 (18.1) | 0.97 (0.48–1.96, p = 0.928) | |
Stop Antibiotics | 94 (29.4) | 59 (18.4) | 0.86 (0.44–1.71, p = 0.659) | |
No Intervention | 15 (4.6) | 7 (2.2) | - |
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Abdelsalam Elshenawy, R.; Umaru, N.; Aslanpour, Z. Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic. COVID 2024, 4, 102-116. https://doi.org/10.3390/covid4010010
Abdelsalam Elshenawy R, Umaru N, Aslanpour Z. Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic. COVID. 2024; 4(1):102-116. https://doi.org/10.3390/covid4010010
Chicago/Turabian StyleAbdelsalam Elshenawy, Rasha, Nkiruka Umaru, and Zoe Aslanpour. 2024. "Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic" COVID 4, no. 1: 102-116. https://doi.org/10.3390/covid4010010