Shifting Patterns of Sputum Culture Testing and Antibiotic Usage Among Patients With Pneumonia Before and After the COVID-19 Pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has greatly shifted the attitude of the public and health care workers toward health care practices. Furthermore, this pandemic led to reduced diagnostic testing of various diseases worldwide. This study investigated the impact of the COVID-19 pandemic on health care practices, mainly focusing on sputum culture testing for pneumonia and how these changes affected antibiotic selection and health outcomes. We conducted a retrospective observational study at the Tokyo Medical University Ibaraki Medical Center between January 2018 and December 2021. We compared clinical outcomes during the pre–COVID-19 and post–COVID-19 periods. These outcomes included microbiological test implementation (eg, sputum culture test), length of hospital stay, and in-hospital mortality. Of the 698 patients, 384 (55.0%) were from the pre–COVID-19 period, and 314 (45.0%) were from the post–COVID-19 period. The post–COVID-19 period was associated with a lower ordering rate of sputum cultures (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50–0.93). Furthermore, the post–COVID-19 period was associated with increased use of narrow-spectrum antibiotics (OR, 1.57; 95% CI, 1.12–2.21) and a higher rate of in-hospital death (OR, 1.78; 95% CI, 1.16–2.73). The COVID-19 pandemic has prompted changes in health care–seeking behaviors, affecting health care providers' diagnostic practices and potentially influencing patient outcomes. Our study outlines the importance of adapting health care strategies during pandemics. Further studies are required to understand the complex interplay among pandemic situations, diagnostic procedures, and patient prognosis.