The Need for Ongoing Antimicrobial Stewardship during the COVID-19 Pandemic and Actionable Recommendations

Abstract

The coronavirus disease (COVID-19) pandemic, which has significant impact on global health care delivery, occurs amid the ongoing global health crisis of antimicrobial resistance. Early data demonstrated that bacterial and fungal co-infection with COVID-19 remain low and indiscriminate use of antimicrobials during the pandemic may worsen antimicrobial resistance It is, therefore, essential to maintain the ongoing effort of antimicrobial stewardship activities in all sectors globally.

Evolution of Antimicrobial Consumption During the First Wave of COVID-19 Pandemic

“…All this evidence underscores the vital role of ASPs in optimizing the use of antimicrobials within hospitals, even more in these special situations such as the COVID-19 pandemic. An interesting perspective highlighted the need for ongoing ASPs during COVID-19 and provided valuable recommendations [ 26 ]. An appropriate use of microbiological tests before the initiation of empiric antibiotic therapy, the promotion of local guidelines, the early de-escalation or discontinuation of therapy when clinical markers are not suggestive of bacterial co-infection, the guidance of antibiotic choice based on microbiological tests results, the early switch from intravenous to oral route, the limitation of the duration of antibiotic treatment to five days, and careful monitoring for potential drug interactions or toxicity are essential to improve antibiotic use during the next waves of the COVID-19 pandemic [ 26 ].…”

“…An interesting perspective highlighted the need for ongoing ASPs during COVID-19 and provided valuable recommendations [ 26 ]. An appropriate use of microbiological tests before the initiation of empiric antibiotic therapy, the promotion of local guidelines, the early de-escalation or discontinuation of therapy when clinical markers are not suggestive of bacterial co-infection, the guidance of antibiotic choice based on microbiological tests results, the early switch from intravenous to oral route, the limitation of the duration of antibiotic treatment to five days, and careful monitoring for potential drug interactions or toxicity are essential to improve antibiotic use during the next waves of the COVID-19 pandemic [ 26 ]. The use of biomarkers such as procalcitonin or C-reactive protein may also be a tool to optimize antibiotic prescribing in this setting, although available evidence is yet of low quality [ 27 ].…”

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

“…The extension of antimicrobial pharmacists' roles beyond traditional duties/activities has also been highlighted by Goff et al (2020) [31]. In addition, a recent review proposed recommendation for harnessing the AMS role of pharmacists and their teams in the context of COVID-19 and importance of continuing to advocate for AMS [32]. More than half of respondents (56%) (Table 7) had to undertake additional training on their own time with only 37% being able to complete additional training and learning needs around COVID-19 within work.…”

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

“…Among the initial recommendations for the treatment of patients presenting COVID-19 symptoms in intensive care units were empirical broad-spectrum antibiotics and neuraminidase inhibitors [ 64 ]. However, the use of broad-spectrum antibiotics can promote C. difficile infection and a rise in antimicrobial resistance [ 16 ].…”

“…Although the early data suggested low rates of coinfection with COVID-19, there is an indiscriminate use of antimicrobials present indicating that antimicrobial stewardship may be another casualty of the COVID-19 pandemic [ 16 , 17 ]. The utilization of established antibiotic stewardship programs has plummeted as healthcare workers struggle to save lives of patients with COVID-19 and are even asked to prioritize COVID-19 response and management [ 16 , 18 ]. According to a study conducted among hospital physicians in Greece, 98.5% stated that antimicrobial stewardship programs must be further developed during the COVID-19 pandemic [ 19 ].…”