Antibiotics
Maria G. Tanzi, PharmD
Experts are concerned that the pandemic could undo much of the nation’s progress on antibiotic resistance, especially in hospitals. “Data show that COVID-19 can create a perfect storm for antibiotic-resistant infections in health care settings,” CDC stated.
The COVID-19 pandemic has contributed to an increase in antibiotic-resistant infections in multiple ways: as a result of staffing shortages, less attention given to antibiotic stewardship; increased patient volume; longer length of stay for patients hospitalized with COVID-19 infections; and difficulties in implementing infection control practices. The prolific use of antimicrobial sanitizers and disinfectants during the pandemic may also contribute to further selection of antibiotic-resistant organisms.
Alarming data
Early on in the pandemic, the lack of sufficient knowledge of the value of antibiotics together with the fear of COVID-19 infection resulted in increased antibiotic use and antimicrobial resistance.
In a retrospective case series published in the BMJ in 2020, for example, almost half of the patients admitted to hospitals outside of the United States for management of COVID-19 received empirical antibiotic treatment.
A more recent multicenter, retrospective, cohort study presented at the 2022 European Congress of Clinical Microbiology & Infectious Diseases examined the possible increase of antimicrobial resistance during the pandemic compared with prepandemic periods.
The study included adults 18 years and older who were admitted to 1 of 271 U.S. hospitals before and during the COVID-19 pandemic, with the prepandemic period including patients admitted from July 1, 2019, to February 29, 2020, and the pandemic period including patients admitted from March 1, 2020, to October 30, 2021. The investigators found that hospital-onset cases of drug-resistant infections were significantly higher during the pandemic than in the pre-pandemic period, with an antimicrobial resistance rate of 0.77 per 100 admissions before the pandemic compared with 0.86 per 100 admissions during the pandemic.
Another recent analysis published online April 8, 2022, in JAMA found that during the first year of the COVID-19 pandemic, 30% of outpatient visits for COVID-19 among Medicare beneficiaries was linked to an antibiotic prescription. Approximately 51% of these prescriptions were for azithromycin, an antibiotic that has not demonstrated benefit in treating COVID-19. Urgent care centers had the highest rates of azithromycin use, and overall antibiotic prescribing was sky high in EDs.
Action needed
These observational data reinforce the importance of improving antibiotic prescribing in both inpatient and outpatient centers. Organizations such as CDC and WHO are actively addressing the rise in antibiotic resistance observed during the COVID-19 pandemic.
Clinicians can play a pivotal role in combating antibiotic resistance. CDC categorizes actions that health care providers can take into 3 groups: preventing infections, improving antibiotic prescribing, and being alert and taking action. Some of these tips are summarized in the table.
“The global COVID-19 pandemic has made clear that public health and health systems need to be more resilient, flexible, and capable of detecting, containing, and stopping public health threats wherever they start,” said CDC. “Antibiotic resistance can spread quickly across health care facilities, countries, and the world. It directly threatens modern medicine and our ability to treat common infections. That’s why a coordinated, global partner–driven approach is critical to addressing antibiotic resistance.” ■
|
Actions for health care providers to combat antibiotic resistance
|
|
Preventing infections
|
Screening at-risk patients when indicated
Evaluating if patients recently received care at another institution or recently traveled to another country
Ensuring patients are up to date on recommended vaccines
Alerting receiving facilities when transferring patients who are colonized or infected with antibiotic-resistant organisms
Educating patients on ways to prevent spread
Staying informed about current outbreaks
|
|
Improving antibiotic prescribing
|
Performing appropriate diagnostic tests to guide antibiotic therapy
(i.e., drug, dose, and duration)
Following treatment guidelines and supporting CDC’s core elements of antibiotic stewardship
Considering fungal infections for patients with respiratory infections that do not respond to antibiotics
Watching for signs of sepsis and treating appropriately
|
|
Being alert and taking action
|
Being aware of infections and resistance patterns in your facility or community
Ensuring immediate notification when antibiotic-resistant organisms are identified in your patients
Educating patients and families if they have an antibiotic-resistant infection
Knowing when to report cases and submit resistant isolates to the health department
|