COVID-19 Mixed Impact on Hospital Antimicrobial Stewardship Activities: A Qualitative Study in UK-Based Hospitals

Abstract

Antimicrobial resistance (AMR) is a well-known global threat due to the subsequent increase in antimicrobial usage. Several antimicrobial stewardship (AMS) strategies have been implemented to curb irrational prescribing and reduce the AMR burden. However, since the beginning of the COVID-19 pandemic, it has enormously impacted the healthcare system and jeopardized public health, causing millions of deaths globally. Our semi-structured qualitative study aimed to explore the impact of COVID-19 on AMS activities in the UK hospitals. Seventeen interviews were conducted with health care professionals who were part of AMS teams (consultant medical microbiologists, infectious disease consultants, antimicrobial pharmacists). Interviews were audio-recorded and transcribed. An inductive thematic framework was adopted to analyse and create the themes. After agreement of the hierarchical framework definition, all transcripts were coded accordingly. Four main themes and 15 sub-themes were identified. These main themes were: (1) AMS activities or strategies before and during the pandemic; (2) challenges to implementing AMS activities before and during the pandemic; (3) information from public authorities on AMS during the pandemic; and (4) new AMS activities/strategies adopted during the pandemic. Staff vacancies, redeploying of AMS staff to other duties and meeting the burden related to the COVID-19 and lack of resources were the most frequently identified contributing factors to withheld AMS activities during the pandemic. However, modifications to the hybrid working environment, i.e., remote or flexible working, allowed for resumption of AMS activities including virtual ward rounds, virtual meetings and other activities. Further research needs to assess the impact of the hybrid delivery system on AMS activities.

The impact of the COVID‐19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

“…Several factors affected AMS during the pandemic, including staff vacancies, redeployment of AMS staff to other duties and meeting the burden related to COVID-19 and lack of resources. 49 Reducing the use of Watch antibiotics and increasing the use of Access antibiotics where availability is low is emphasized as an overall goal. As a target by 2023, 60% of all antibiotics consumed must come from the group of antibiotics at lowest risk of resistance, that is, the Access group.…”

“…Analysis of hospital data showed a decrease in the use of the Access group and an increase in the use of the Watch group. Several factors affected AMS during the pandemic, including staff vacancies, redeployment of AMS staff to other duties and meeting the burden related to COVID‐19 and lack of resources 49 . Reducing the use of Watch antibiotics and increasing the use of Access antibiotics where availability is low is emphasized as an overall goal.…”

Healthcare commissioners’ experience with antibiotic resistance during the COVID-19 pandemic in Saudi Arabia: a qualitative study

“…A qualitative study conducted in the United Kingdom indicated that ASP ward rounds had been implemented effectively before the pandemic, while during the pandemic, they were neglected due to staff pressure (Khan et al, 2022 ). Another study found that engagement of the ASP teams during the COVID-19 pandemic was affected by the pandemic or almost not functioning (Borek et al, 2021 ).…”

Shorter and Longer Antibiotic Durations for Respiratory Infections: To Fight Antimicrobial Resistance—A Retrospective Cross-Sectional Study in a Secondary Care Setting in the UK

“…In response to this crisis, antimicrobial stewardship (AMS) initiatives have become crucial, promoting the responsible use of antibiotics to mitigate the risks associated with AMR [ 7 , 8 ]. The importance of AMS programs is highlighted by the rapid spread of AMR, which complicates the management of infectious diseases [ 9 , 10 ].…”