Antimicrobial stewardship in patients with confirmed coronavirus disease 2019 (COVID-19)

Abstract

173 hospitalized COVID-19 patients receiving antibiotics were retrospectively assigned to the early or late discontinuation groups. Length of therapy was shorter in the early discontinuation group (3 vs 7 days, p<0.0001). Mortality (14.3% vs 20.7%, p=0.316) and length of stay (7 vs. 9 days, p=0.063) were similar.

Risk factors for hospital-acquired infection during the SARS-CoV-2 pandemic

“… 1 There is now a trend towards improving antimicrobial stewardship for hospitalized patients with SARS-CoV-2. 2 , 3 …”

SHEA statement on antibiotic stewardship in hospitals during public health emergencies

“…58 Many reports have highlighted that targeted stewardship interventions were effective in reducing antibiotic use among patients infected with SARS-CoV-2. 93,98 ASP efforts during the COVID-19 pandemic have gone far beyond antibiotic management. They have been crucial to assess to emerging treatment regimens for COVID-19, implementing use of remdesivir, dexamethasone, or interleukin-6 inhibitors, and providing expertise and resources to help implement monoclonal antibody treatment and COVID-19 vaccinations.…”

“…58 Many reports have highlighted that targeted stewardship interventions were effective in reducing antibiotic use among patients infected with SARS-CoV-2. 93 , 98 …”

Practical Insight into Understanding the Clinical Conundrum of Viral Community-acquired Pneumonia: A Review

“…Moore et al and Heesom et al conducted single-center trials and observed no difference in mortality in COVID-19 patients when antibiotics were discontinued based on a recommendation from antimicrobial stewardship programs using PCT guidance. 48,49 Moradi et al conducted a multi-site quasi-experimental study describing a pre and post period when the electronic health record began displaying a recommendation to consider discontinuing antibiotics to prescribers if adult patients had a PCT result < 0.25 ng/mL and a positive viral respiratory PCR within 48 hours of each another. This study found a reduction in mean antibiotic days (5.8 vs 8, p <0.001) without a difference in antibiotic restarts after discontinuation.…”

“…Though retrospective data exists in limiting antibiotics in patients with viral CAP, these studies are limited by being single-center and uncontrolled. [48][49][50] There is a need for a standardized clinical and microbiologic approach to assessing risk of bacterial co-infection which should be developed and rigorously tested in a prospective, randomized controlled trial. Ideally, such an approach would be validated in multiple viruses, geographic regions and patient populations, including those who are critically-ill or immunocompromised.…”