How Has The COVID-19 Pandemic Impacted Stewardship Efforts and Antibiotic Use?

By the bioMérieux Connection Editors

Antibiotic resistance was a major problem before the onset of COVID-19—a CDC report released in November of last year revealed that more than 2.8 million antibiotic-resistant infections occur in the US each year, and more than 35,000 people die as a result. To combat resistance, there are antibiotic stewardship programs (ASPs) in hospitals and healthcare systems, which work to promote and maintain the appropriate and judicious use of antibiotics.

An analysis of coronavirus studies published in early May found that 72% of hospitalized COVID-19 patients received antimicrobial therapy, but that only 8% had a bacterial or fungal co-infection. The authors of the study acknowledge that their review has several limitations that must be considered, and that data is continuously evolving, but they conclude that, “Generation of prospective evidence to support development of antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic are urgently required.”

The Pandemic’s Impact on Antimicrobial Use

According to a recent MedPage Today article, despite the viral origin of COVID-19, a standard reflex is to start antibiotic treatment immediately, largely because symptoms are similar to those of bacterial pneumonia. “It is prudent. It’s hard when these patients present because they look like they have [bacterial] pneumonia,” Elizabeth Hirsch, PharmD, of the University of Minnesota told MedPage Today.

The lack of effective antiviral treatments may also be a contributor to initial antimicrobial therapy, as well as the uncertainty surrounding the pandemic. A pandemic puts pressure on everyone, but this is especially true for healthcare professionals, who are presented with a large number of patients every day as well as a deluge of inconsistent information on how best to test and treat them.

Diagnostic Stewardship Can Contribute to Antimicrobial Stewardship Amidst COVID-19

Diagnostics can play a role in stewardship throughout the pandemic by facilitating a quick diagnosis of COVID-19 and identifying if there is also a bacterial co-infection. Timothy Rawson, PhD, of Imperial College London and author of the previously mentioned analysis, stated to MedPage Today that the focus must be on stopping inappropriate antibiotics early during a patient’s admission. “This requires the clinician to send appropriate diagnostic tests for all patients admitted with COVID-19. They must regularly review antibiotic prescriptions and stop them when there is little evidence of bacterial co-infection,” he went on to say.  

Molecular tests, such as Real-time Polymerase Chain Reaction (RT-PCR) tests, have become a crucial component in the fight against COVID-19, as these systems often permit a shortened turnaround time for reporting results. Faster results can enable clinicians to better optimize treatment for patients, including ceasing antibiotics if they are not needed. Another way to potentially support appropriate antimicrobial prescribing is through the use of specific biomarkers, such as procalcitonin (PCT). PCT has been shown to provide guidance on differentiating between bacterial and non-bacterial infections and supports early cessation of antibiotics in confirmed bacterial infection with no effect on patient mortality.

Data Can Help Optimize Stewardship Efforts

As cases of COVID-19 seem to be slowing down across the US, there is hope that data will aid in promoting stewardship initiatives. As hospitals begin to catch their breath, health professionals can analyze data collected throughout the pandemic and assess antibiotic usage, bacterial or fungal co-infections, and co-infection risk factors. A deeper understanding of this novel coronavirus over time can help provide guidance on patient management, particularly the use of antimicrobials.

“Data gives you knowledge to make good decisions…and then knowledge gives you power to make informed medical decisions,” said Debbie Goff, PharmD, who specializes in infectious diseases and antibiotic stewardship, in a recent CIDRAP article. “We’ve been making very many emotional decisions, and rightfully so, but now as we get more data, we have to move to science.”

The future of this novel coronavirus remains uncertain, but epidemiologists agree on one thing—it’s not going away. Experts predict varying scenarios involving COVID-19 outbreaks over the next two years. Addressing resistance concerns now can help better prepare hospitals for the unknown future.

Opinions expressed in this article are not necessarily those of bioMérieux, Inc.

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