Evaluating Antibiotic Review Timing, Clinical Characteristics, and Stewardship Interventions to Confront Antimicrobial Resistance: A Retrospective Cohort Study of 640 Patients in Two UK Hospitals Before and During the COVID-19 Pandemic

Antimicrobial resistance (AMR) remains a major global threat, with stewardship frameworks such as the UKHSA Start Smart – Then Focus (SSTF) essential for optimising antibiotic use. This retrospective cohort study evaluated antibiotic review timing and stewardship interventions in 640 adult inpatients treated for respiratory tract infections at two NHS hospitals in England during 2019 (pre-COVID-19) and 2020 (during COVID-19). Data included patient demographics, comorbidities, WHO AWaRe antibiotic classification, and timing of reviews (Days 2–3, 4, 7). Despite increased use of broad-spectrum Watch antibiotics during the pandemic (46.3%–65.0%), Reserve antibiotic use remained below 2%. Early reviews (within 72 hours) were sustained in over half of cases, enabling timely de-escalation (up to 27.5%) and cessation (up to 35.6%). Differences in prescribing and diagnostics were observed between hospitals. The study highlights the resilience of AMS practices during pandemic pressures and supports strengthening review protocols and AWaRe integration to maintain prescribing quality during health system disruptions.