Division of Infectious Diseases, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Division of Geriatric Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
J Am Med Dir Assoc. 2024 Feb;25(2):290-295. doi: 10.1016/j.jamda.2023.10.003. Epub 2023 Nov 6.
Little is known about deployment of SARS-CoV-2-neutralizing monoclonal antibodies (mab) in skilled nursing facilities (SNFs), a high-risk population for COVID-19-related complications. We assessed the utilization of mabs in SNFs and identified facility characteristics associated with effective use.
Retrospective cohort study assessing the correlation of SNF characteristics with increasing mab use.
United States SNFs participating in Project ECHO (Extensions for Community Health Outcomes).
The primary outcome was percentage of total mabs per COVID-19 cases in SNFs. Facilities were divided into 3 groups based on the percentage of the administration of mabs per number of cases: 0%, >0% to 20%, >20%. Ordinal logistic regression was applied to assess whether facility characteristics-study group, state, location, type, size, rating at baseline, weekly average of residents vaccinated, weekly average of staff vaccinated, and total weeks short staffed-correlated with the primary outcome. A multivariable model was used to evaluate the independent effect of predictors.
A total of 130 facilities were included. Between the weeks ending on May 30, 2021, and on May 29, 2022, mean mab use when accounting for the number of COVID-19 cases was 12.96% (±26.71%) and >50% of facilities administered 0 doses of mabs. Facility location was associated with mab use (P value .030), with micropolitan facilities having the highest percentage of facilities administering mabs (30.4% in >0% to 20%, and 39.1% in >20%, respectively). There was a nonsignificant trend toward increased mab use in facilities reporting fewer staffing shortages. When the multivariable ordinal logistic regression model was applied, location in a micropolitan vs metropolitan area was associated with higher odds [3.29 (1.30, 8.32), P value .012] of increasing percentage total mabs per cases.
COVID-19 mabs were underutilized in a high-risk population for COVID-19 hospitalization and death. Understanding the barriers to effective distribution is critical in shaping pandemic preparedness efforts for the future.
关于严重急性呼吸系统综合征冠状病毒 2 中和单克隆抗体（mab）在熟练护理机构（SNF）中的部署情况知之甚少，SNF 是与 COVID-19 相关并发症相关的高风险人群。我们评估了 SNF 中 mab 的使用情况，并确定了与有效使用相关的设施特征。
评估 SNF 特征与 mab 使用增加相关性的回顾性队列研究。
参与 ECHO 项目（社区卫生成果扩展）的美国 SNF。
主要结果是 SNF 中每例 COVID-19 病例的 mab 总数百分比。根据 mab 给药数量与病例数量的百分比，将设施分为 3 组：0%、>0%至 20%、>20%。应用有序逻辑回归评估设施特征-研究组、州、地点、类型、规模、基线时的评级、每周平均接种居民人数、每周平均接种工作人员人数和总缺员周数-与主要结果是否相关。使用多变量模型评估预测因子的独立影响。
共纳入 130 家机构。在 2021 年 5 月 30 日至 2022 年 5 月 29 日当周结束时，考虑 COVID-19 病例数时，mab 的平均使用量为 12.96%（±26.71%），超过 50%的机构未使用 mab。设施位置与 mab 使用相关（P 值.030），大都市设施中使用 mab 的设施比例最高（分别为>0%至 20%为 30.4%，>20%为 39.1%）。报告人员短缺较少的设施中，mab 使用呈上升趋势，但无统计学意义。当应用多变量有序逻辑回归模型时，位于大都市与大都市地区的设施与增加每例病例 mab 总数百分比的可能性更高相关[3.29（1.30，8.32），P 值.012]。
COVID-19 中和 mab 在 COVID-19 住院和死亡高风险人群中使用不足。了解有效分配的障碍对于未来塑造大流行防范工作至关重要。
