Assessing the Impact of COVID-19 on Antimicrobial Stewardship Activities/Programs in the United Kingdom

Abstract

Since first identified in late 2019, the acute respiratory syndrome coronavirus (SARS-CoV2) and the resulting coronavirus disease (COVID-19) pandemic has overwhelmed healthcare systems worldwide, often diverting key resources in a bid to meet unprecedented challenges. To measure its impact on national antimicrobial stewardship (AMS) activities, a questionnaire was designed and disseminated to antimicrobialstewardship leads in the United Kingdom (UK). Most respondents reported a reduction in AMS activity with 64% (61/95) reporting that COVID-19 had a negative impact on routine AMS activities. Activities reported to have been negatively affected by the pandemic include audit, quality improvement initiatives, education, AMS meetings, and multidisciplinary working including ward rounds. However, positive outcomes were also identified, with technology being increasingly used as a tool to facilitate stewardship, e.g., virtual meetings and ward rounds and increased the acceptance of using procalcitonin tests to distinguish between viral and bacterial infections. The COVID-19 pandemic has had a significant impact on the AMS activities undertaken across the UK. The long-term impact of the reduced AMS activities on incidence of AMR are not yet known. The legacy of innovation, use of technology, and increased collaboration from the pandemic could strengthen AMS in the post-pandemic era and presents opportunities for further development of AMS.

Prevalence of Antibiotic Resistance of ESKAPE Pathogens Over Five Years in an Infectious Diseases Hospital from South-East of Romania

“…3 , 19 , 20 The current COVID-19 (Coronavirus disease of 2019) pandemic context has changed the priorities of the medical activity by influencing antibiotic use with unknown consequences in the long run. 21 …”

“…3,19,20 The current COVID-19 (Coronavirus disease of 2019) pandemic context has changed the priorities of the medical activity by influencing antibiotic use with unknown consequences in the long run. 21 This study aimed to evaluate the evolution of the main antimicrobial resistance issues, as part of the stewardship antibiotic program in an infectious diseases hospital which is representative for the south-east region of Romania.…”

The Pandemic beyond the Pandemic: A Scoping Review on the Social Relationships between COVID-19 and Antimicrobial Resistance

“…A summary with the key findings can be seen in Table 1. Literature reports great concern among healthcare workers regarding excessive prescription rates, the use of broad-spectrum antibiotics, prolonged antibiotic treatments without clinical justification, and inappropriate prescribing of antibiotics to patients infected with COVID-19 [7][8][9][10][11][12]. For example, in the United Kingdom, Zhu et al found that clinicians prescribed more broad-spectrum antibiotics due to the inability to assess patients face-to-face [13].…”

“…The COVID-19 challenges combine with ongoing lack of knowledge about proper antibiotic use among health professionals, including a "just-in-case" prescription [8,17,18], and the use of experimental antibiotic treatments due to the absence of specific treatments against COVID-19 that might increase the use of non-essential antibiotics [9,11,17]. The "just-in-case" prescription was related to the decrease in education and training activities included in the AMS programmes, negatively affected by the pandemic [8]. Added to this is clinical uncertainty about COVID-19, leading clinicians to prescribe antibiotics without medical indication, based on the perception that the potential benefit was greater than the risk [16,17].…”

“…Several antimicrobial stewardship (AMS) programmes were established after releasing the Global Action Plan for Antimicrobial Resistance. Unfortunately, after the beginning of the COVID-19 pandemic, many of these programmes were reduced in terms of both workforce and stewardship activities (audit, quality assessment, education and training, improvement initiatives, hospital rounds), as COVID-19 was prioritised above AMR [7,8,10,12,17,24]. Hospitals made sure they had sufficient supply of antibiotics, however, the limited resources for antimicrobial stewardship programmes indirectly impacted antibiotic use, leading to an increase in AMR [17].…”