Impact of the strategies implemented by an antimicrobial stewardship program on the antibiotic consumption in the coronavirus disease 2019 (COVID-19) pandemic

Murgadella‐Sancho, Anna; Coloma-Conde, Ana; Oriol, Isabel

doi:10.1017/ice.2021.237

Cited by 14 publications

(30 citation statements)

References 8 publications

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“…During the early phases of the COVID-19 pandemic, it has been observed that antibiotics were prescribed more indiscriminately for respiratory tract infections globally, both in the acute hospitals as well as in the community setting. In Spain, the use of ceftriaxone and azithromycin peaked in March and April 2020, similar to the observations in Singapore General Hospital [ 4 , 14 , 15 ]. As highlighted by a group of general practitioners in a focused group discussion conducted in the United Kingdom, there was a lower threshold for initiating antibiotics for respiratory tract infections in a pandemic, especially when the cause was unclear [ 16 ].…”

Section: Discussionsupporting

confidence: 77%

Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic

et al. 2022

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At the start of the COVID-19 pandemic, there was an increase in the use of antibiotics for the treatment of community-acquired respiratory tract infection (CA-ARI) in patients admitted for suspected or confirmed COVID-19, raising concerns for misuse. These antibiotics are not under the usual purview of the antimicrobial stewardship unit (ASU). Serum procalcitonin, a biomarker to distinguish viral from bacterial infections, can be used to guide antibiotic recommendations in suspected lower respiratory tract infection. We modified our stewardship approach, and used a procalcitonin-guided strategy to identify “high yield” interventions for audits in patients admitted with CA-ARI. With this approach, there was an increase in the proportion of patients with antibiotics discontinued within 4 days (16.5% vs. 34.9%, p < 0.001), and the overall duration of antibiotic therapy was significantly shorter [7 (6–8) vs. 6 (3–8) days, p < 0.001]. There was a significant decrease in patients with intravenous-to-oral switch of antibiotics to “complete the course” (45.3% vs. 34.4%, p < 0.05). Of the patients who had antibiotics discontinued, none were restarted on antibiotics within 48 h, and there was no-30-day readmission or 30-day mortality attributed to respiratory infection. This study illustrates the importance of the antimicrobial stewardship during the pandemic and the need for ASU to remain attuned to prescriber’s practices, and adapt accordingly to address antibiotic misuse to curb antimicrobial resistance.

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Section: Discussionsupporting

confidence: 77%

Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic

et al. 2022

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“…Throughout the COVID-19 pandemic, significant healthcare resource strain has been described, leading to reduced or suspended ASP interventions. [6][7][8] However, data describing the use of antibiotics in hospitalized patients throughout the many waves of the current pandemic are limited, especially in North America. In our study, clear prescribing trends evolved similarly in 3 large, acute-care hospitals that continued core ASP activities and followed the same regional COVID-19 therapeutic guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 However, at the outset of the pandemic, many ASPs worldwide temporarily halted or reduced their functions, due to many factors including staff redeployment. [6][7][8] At the beginning of the pandemic, increased antibiotic prescribing may have been caused by evolving COVID-19 diagnostic criteria and the unclear risk of concomitant bacterial pneumonia with a novel viral pathogen.…”

mentioning

confidence: 99%

Trends in hospital antibiotic utilization during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter interrupted time-series analysis

Elligsen

Wan

Lam

et al. 2022

ASHE

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Objective: To describe the evolution of respiratory antibiotic prescribing during the coronavirus disease 2019 (COVID-19) pandemic across 3 large hospitals that maintained antimicrobial stewardship services throughout the pandemic. Design: Retrospective interrupted time-series analysis. Setting: A multicenter study was conducted including medical and intensive care units (ICUs) from 3 hospitals within a Canadian epicenter for COVID-19. Methods: Interrupted time-series analysis was used to analyze rates of respiratory antibiotic utilization measured in days of therapy per 1,000 patient days (DOT/1,000 PD) in medical units and ICUs. Each of the first 3 waves of the pandemic were compared to the baseline. Results: Within the medical units, use of respiratory antibiotics increased during the first wave of the pandemic (rate ratio [RR], 1.76; 95% CI, 1.38–2.25) but returned to the baseline in waves 2 and 3 despite more COVID-19 admissions. In ICU, the use of respiratory antibiotics increased in wave 1 (RR, 1.30; 95% CI, 1.16–1.46) and wave 2 of the pandemic (RR, 1.21; 95% CI, 1.11–1.33) and returned to the baseline in the third wave, which had the most COVID-19 admissions. Conclusions: After an initial surge in respiratory antibiotic prescribing, we observed the normalization of prescribing trends at 3 large hospitals throughout the COVID-19 pandemic. This trend may have been due to the timely generation of new research and guidelines developed with frontline clinicians, allowing for the active application of new research to clinical practice.

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“…AMS programmes that quickly adapted to the pandemic context have proven to be able to reduce antibiotic prescription and the duration of therapy through modified protocols and the aid of computer systems and of non-clinical figures such as pharmacists. 51 – 53 Solutions to new challenges offered by the pandemic, especially the extensive use of technology and web-based strategies (app software, emails and videoconferencing) may continue even in the post-pandemic period to improve AMS services. 54 An Italian survey showed that non-infectious disease specialists tend to prescribe more antibiotics, possibly due to a lack of knowledge of AMS principles.…”

Section: Problems Of Ams In Daily Practice In Covid-19 and Possible S...mentioning

confidence: 99%

Improving management and antimicrobial stewardship for bacterial and fungal infections in hospitalized patients with COVID-19

Peghin

Vena

Graziano

et al. 2022

Therapeutic Advances in Infection

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SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection is being one of the most significant challenges of health care systems worldwide. Bacterial and fungal infections in hospitalized patients with coronavirus disease 2019 (COVID-19) are uncommon but consumption of antibiotics and antifungals has increased dramatically during the ongoing pandemic resulting in increased selective pressure for global antimicrobial resistance. Nosocomial bacterial superinfections appear to be more frequent than community-acquired coinfections, particularly among patients admitted to the intensive care unit (ICU) and those receiving immunosuppressive treatment. Fungal infections associated with COVID-19 might be missed or misdiagnosed. Existing and new antimicrobial stewardship (AMS) programmes can be utilized directly in COVID-19 pandemic and are urgently needed to contain the high rates of misdiagnosis and antimicrobial prescription. The aim of this review is to describe the role of bacterial and fungal infections and possible strategies of AMS to use in daily practice for optimal management of COVID-19.

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Impact of the strategies implemented by an antimicrobial stewardship program on the antibiotic consumption in the coronavirus disease 2019 (COVID-19) pandemic

Cited by 14 publications

References 8 publications

Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic

Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic

Trends in hospital antibiotic utilization during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter interrupted time-series analysis

Improving management and antimicrobial stewardship for bacterial and fungal infections in hospitalized patients with COVID-19

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