Antimicrobial stewardship implementation before and during the COVID-19 pandemic in the acute care settings: a systematic review

Abstract

Introduction Antibiotics are widely administered for various indications, leading to increased antimicrobial resistance (AMR) in acute care hospitals. Since the onset of the COVID-19 pandemic, Antimicrobial Stewardship (AMS) effective strategies should be used to maintain the rational use of antibiotics and decrease the threat of Antimicrobial Resistance (AMR). Aim This systematic literature review aims to investigate the AMS intervention Before-the-pandemic (BP) and During-the-pandemic (DP) from the literature. Design and setting Systematic literature review of primary studies on AMS implementation in acute care settings. Methods Relevant studies published between 2000 and March 2021 were obtained from Medline (via PubMed), OVID, CINAHL, International Pharmaceutical Abstracts, Psych Info, Scopus, Web of Science, Cochrane Library, OpenGrey, and Google Scholar, using a comprehensive list of search terms. Public Health England (PHE) toolkit was agreed upon as a gold standard for the AMS implementation. Results There were 8763 articles retrieved from the databases. Out of these, 13 full-text articles met the inclusion criteria for the review. The AMS implementation was identified in the included studies into AMS strategies (Core strategies & Supplemental strategies), and AMS measures BP and DP. Conclusion This Systematic literature review summarises AMS implementation strategies and measures all over the previous 20 years of research. There are many lessons learnt from COVID-19 pandemic. The proper selection of the AMS implementation strategies and measures appeared to be effective in maintaining the appropriate use of antibiotics and decreasing the AMR threat, especially during the COVID-19 pandemic. Further studies are required to provide empirical data to evaluate the AMS implementation and identify which of these strategies and measures were effective BP and DP. In order to be prepared for any emergency/crisis or future pandemics.

WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance – a descriptive study from an English NHS Foundation Trust prior to and during the COVID-19 pandemic

“…COVID-19 highlighted the effectiveness of antimicrobial stewardship (AMS) in combating AMR by guiding strategic choices during the pandemic and encouraging judicious antibiotic use. Findings from this study showed that amoxicillin/clavulanic acid, classified in the “Access group,” emerged as the most frequently prescribed antibiotic ( Elshenawy et al, 2023 ).…”

“…Antimicrobial resistance (AMR) constitutes a silent and rapidly escalating pandemic, presenting a critical challenge to global health security ( Salam et al, 2023 ). The introduction of penicillin in the 1920s was a transformative era in the field of infection management, significantly diminishing mortality rates associated with infections ( Elshenawy et al, 2023 ). Despite these advances, the emergence and escalation of AMR, primarily attributed to the inappropriate prescription of antibiotics, casts a long shadow over these achievements.…”

Antibiotic prescribing to inpatients in Limpopo, South Africa: a multicentre point-prevalence survey

“…Lack of documentation indicates poor prescribing practices; ASP should address gaps by deploying evidence-based, multifaceted and stepwise interventions. [ 16 , 73 ].…”

Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic

“…This toolkit promotes timely, responsible antibiotic use by initiating effective therapies and then actively reviewing regimens within 24-72 h. The 'Start Smart, Then Focus' principles apply to all antibiotic prescriptions to streamline antimicrobial use. Antimicrobial stewardship encompasses interventions aimed at improving appropriate antibiotic prescribing across all healthcare settings [6,7].…”