Antimicrobial stewardship in the ICU in COVID-19 times: the known unknowns

Schouten, Jeroen; Waele, Jan J. De; Lanckohr, Christian; Koulenti, Despoina; Haddad, Nisrine; Sjövall, Fredrik; Kanj, Souha S.

doi:10.1016/j.ijantimicag.2021.106409

Cited by 34 publications

(42 citation statements)

References 105 publications

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“…(9) In addition, the reported cohorts included patients with varying disease severity, which may confound the interpretation of PCT in COVID-19. (10) In line with this hypothesis, we have demonstrated that PCT levels are associated with clinical severity in non-COVID respiratory viral infection. (11) 2 Therefore, we sought to evaluate the diagnostic utility of PCT for bacterial superinfection in COVID-19specifically in hospitalized patients with severe disease.…”

Section: Textsupporting

confidence: 69%

Nonutility of procalcitonin for diagnosing bacterial pneumonia in COVID-19

Cohen¹,

Glick²,

Lee³

et al. 2022

Preprint

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Patients hospitalized with COVID-19 are at significant risk for superimposed bacterial pneumonia. However, diagnosing superinfection is challenging due to its clinical resemblance to severe COVID-19. We therefore evaluated whether the immune biomarker, procalcitonin, could facilitate the diagnosis of bacterial superinfection. To do so, we identified 185 patients with severe COVID-19 who underwent lower respiratory culture; 85 had superinfection. Receiver operating characteristic curve analysis showed that procalcitonin at the time of culture was incapable of distinguishing patients with bacterial infection (AUC, 0.52). We conclude that static measurement of procalcitonin does not aid in the diagnosis of superinfection in severe COVID-19.

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Section: Textsupporting

confidence: 69%

Nonutility of procalcitonin for diagnosing bacterial pneumonia in COVID-19

Cohen¹,

Glick²,

Lee³

et al. 2022

Preprint

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“…Unfortunately, to date some countries under conflict continue to have poor or no access to COVID-19 vaccination. Strengthening AMS practices in COVID-19 patients through putting clear management guidelines of antimicrobials prescription and use of biomarkers such as procalcitonin might help decrease the impact of the pandemic on antimicrobial use [ 17 , 101 ]. Furthermore, clear national guidelines on antiviral and antiparasitic use in COVID-19 would also address the issue of overuse of these drugs.…”

Section: Main Ams Interventions Obstacles and Proposed Solutionsmentioning

confidence: 99%

“…A recent report from the American National Health Safety Network (NHSN) suggests a sharp increase in the rates of resistant pathogens post COVID-19 [ 15 ]. Since COVID-19 presents mostly with respiratory symptoms including fever that can be easily confused with bacterial infections, the spread of the virus was associated with a sharp increase in antimicrobial use [ 16 , 17 ]. In addition, a large percentage of hospitalized patients with COVID-19, particularly those requiring mechanical ventilation and intensive care unit (ICU) admission, received broad-spectrum antimicrobial agents despite negative cultures [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Since COVID-19 presents mostly with respiratory symptoms including fever that can be easily confused with bacterial infections, the spread of the virus was associated with a sharp increase in antimicrobial use [ 16 , 17 ]. In addition, a large percentage of hospitalized patients with COVID-19, particularly those requiring mechanical ventilation and intensive care unit (ICU) admission, received broad-spectrum antimicrobial agents despite negative cultures [ 17 , 18 ]. Because of the concern of acquiring infections with drug-resistant pathogens, broad-spectrum antibiotics were used for an extended duration in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Challenges to Antimicrobial Stewardship in the Countries of the Arab League: Concerns of Worsening Resistance during the COVID-19 Pandemic and Proposed Solutions

et al. 2021

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The COVID-19 pandemic is expected to worsen the global problem of antimicrobial resistance (AMR). There is a heightened interest in understanding this effect and to develop antimicrobial stewardship (AMS) interventions accordingly to curb this threat. Our paper aims to evaluate the potential magnitude of COVID-19 on AMR and AMS with a focus on the countries of the Arab league, given the social, political, and economic environments. We also evaluate obstacles in applying the rational use of antibiotics, monitoring resistance trends in the midst of the pandemic, and evaluating the impact of the economic crisis in some countries. We aim to raise awareness about the potential effects of antibiotic overuse during the pandemic and to propose practical approaches to tackle this issue.

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“…Even though the majority of SARS-CoV-2 cases only develop mild symptoms [ 17 , 18 , 19 ], a substantial share of them evolve into acute respiratory failure and require intensive care, including intensive care units (ICU) and mechanical ventilation, with a dismal prognosis. According to available data, 90% of the critically ill patients with severe SARS-CoV-2 pneumonia receive empiric antibiotic treatment upon ICU admission [ 20 , 21 , 22 ], and early reports have suggested high rates of bacterial co-infections [ 23 , 24 , 25 , 26 ], including the Legionella species [ 27 ], with a poor prognosis [ 28 , 29 ]. For example, in an early study from Xing et al [ 27 ], the prevalence rate for SARS-CoV-2- Legionella co-infections peaked at an unprecedented 20.0% in 30 ICU patients.…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2–Legionella Co-Infections: A Systematic Review and Meta-Analysis (2020–2021)

et al. 2022

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Legionnaires’ Disease (LD) is a severe, sometimes fatal interstitial pneumonia due to Legionella pneumophila. Since the inception of the SARS-CoV-2 pandemic, some contradictory reports about the effects of lockdown measures on its epidemiology have been published, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE) focusing on studies that reported the occurrence of LD among SARS-CoV-2 cases. Data were extracted using a standardized assessment form, and the results of such analyses were systematically reported, summarized, and compared. We identified a total of 38 articles, including 27 observational studies (either prospective or retrospective ones), 10 case reports, and 1 case series. Overall, data on 10,936 SARS-CoV-2 cases were included in the analyses. Of them, 5035 (46.0%) were tested for Legionella either through urinary antigen test or PCR, with 18 positive cases (0.4%). A pooled prevalence of 0.288% (95% Confidence Interval (95% CI) 0.129–0.641), was eventually calculated. Moreover, detailed data on 19 co-infections LD + SARS-CoV-2 were obtained (males: 84.2%; mean age: 61.9 years, range 35 to 83; 78.9% with 1 or more underlying comorbidities), including 16 (84.2%) admissions to the ICU, with a Case Fatality Ratio of 26.3%. In summary, our analyses suggest that the occurrence of SARS-CoV-2–Legionella infections may represent a relatively rare but not irrelevant event, and incident cases are characterized by a dismal prognosis.

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Antimicrobial stewardship in the ICU in COVID-19 times: the known unknowns

Cited by 34 publications

References 105 publications

Nonutility of procalcitonin for diagnosing bacterial pneumonia in COVID-19

Nonutility of procalcitonin for diagnosing bacterial pneumonia in COVID-19

Challenges to Antimicrobial Stewardship in the Countries of the Arab League: Concerns of Worsening Resistance during the COVID-19 Pandemic and Proposed Solutions

SARS-CoV-2–Legionella Co-Infections: A Systematic Review and Meta-Analysis (2020–2021)

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