Involving antimicrobial stewardship programs in COVID-19 response efforts: All hands on deck

Stevens, Michael P.; Patel, Payal; Nori, Priya

doi:10.1017/ice.2020.69

Cited by 105 publications

(106 citation statements)

References 4 publications

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“…Severe COVID-19 can easily mimic bacterial sepsis [14,29] and this has certainly led many physicians to prescribing antibiotic treatment which then has proven not to be justi ed. This result shows that, during the peak of the outbreak, the principles of antimicrobial stewardship were implemented less strictly, a problem which has been highlighted in the literature [20,21]. Our data do not support the use of antimicrobials in COVID-19 unless a bacterial/fungal superinfection is suspected.…”

Section: Discussioncontrasting

confidence: 56%

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Bardi

Pintado

Gómez-Rojo

et al. 2020

Preprint

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Background: Bacterial and fungal co-infection has been reported in patients with COVID-19, but there is limited experience on these infections in critically ill patients.Aim: To assess the characteristics and outcome of ICU-acquired infections in COVID-19 patients.Methods: In this retrospective single-centre, case-control study, we included 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical and microbiological features, and outcome of ICU-acquired infections.Results: Fifty seven patients (40.7%), developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission, and was significantly associated with the APACHE II score (p=0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%) and urinary tract infection (8%), that were produced by a wide spectrum of Gram positive (55%) and Gram negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock, and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2-5.9, p=0.015), and a longer ICU stay (p<0.001).Conclusions: Bacterial and fungal nosocomial infection is a common complication of ICU admission in patients with COVID-19. It usually presents as a severe form of infection and it is associated with a high mortality and longer course of ICU stay.

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Section: Discussioncontrasting

confidence: 56%

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Bardi

Pintado

Gómez-Rojo

et al. 2020

Preprint

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“…Several issues related to the COVID-19 epidemic are starting to cause concern including the occurrence of bacterial and fungal infections, the plausible crisis of antimicrobial stewardship programs and an increase in antimicrobial resistance [1] , [2] , [3] . The real extent of these issues is poorly known due to the lack of ad hoc studies.…”

mentioning

confidence: 99%

Incidence of bacterial and fungal bloodstream infections in COVID-19 patients in intensive care: An alarming “collateral effect”

Cataldo

Tetaj

Selleri

et al. 2020

Journal of Global Antimicrobial Resistance

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Highlights COVID-19 patients have an exaggerated risk of acquiring BSI during ICU stay The incidence of ICU-acquired BSI in COVID-19 patients is higher than that reported in European ICUs in the pre-COVID-19 period The commonest etiologic agents of BSI were intestinal commensals. A high rate of acquisition of VRE colonisation was observed.

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“…Needless to say, we meticulously reviewed our antimicrobial choices on a daily basis, based on widely accepted principles of antimicrobial stewardship in regard to de-escalation, rationalisation and total duration of treatment [9]. As already mentioned, and based on our small experience so far, patients may not need more than 5 days of antimicrobial treatment per episode of deterioration, even the ones who have developed adult respiratory distress syndrome.…”

Section: Discussionmentioning

confidence: 99%

Initial Real-Life Experience from a Designated COVID-19 Centre in Athens, Greece: a Proposed Therapeutic Algorithm

Baraboutis

Gargalianos

Aggelonidou

et al. 2020

SN Compr. Clin. Med.

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We report our initial experience with the management of a mixed group of patients with COVID-19 infection, admitted and treated in a designated COVID-19 centre in the Athens Metropolitan area over a 4-week period. The SARS-CoV-2 pandemic presented a huge challenge to the Greek National Healthcare System and healthcare workers. Their response so far has been miraculously effective. Since there are essentially no therapeutic guidelines yet for this disease, we relied mainly on our medical intuition, our empathy for our patients and team work to do the best possible for 49 people with this infection. We present the therapeutic algorithm we gradually developed (on the job) and applied in our patients, based on continuous creative brainstorming and monitoring of the literature. Keywords COVID-19 infection. Coinfections. Bovine coronavirus. Ferritin. C-reactive protein. D-dimer. Viral replication. Human immunodeficiency virus (HIV). Pneumocystis jiroveci pneumonia. Oral candidiasis. Adult respiratory distress syndrome. Cytokine release syndrome. Immunomodulatory therapy. Interleukin-6. Interleukin-1. Soluble urokinase-type plasminogen activator receptor. Antimicrobial therapy. Corticosteroids. Lung microbiota This article is part of the Topical Collection on COVID-19

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Involving antimicrobial stewardship programs in COVID-19 response efforts: All hands on deck

Cited by 105 publications

References 4 publications

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Incidence of bacterial and fungal bloodstream infections in COVID-19 patients in intensive care: An alarming “collateral effect”

Initial Real-Life Experience from a Designated COVID-19 Centre in Athens, Greece: a Proposed Therapeutic Algorithm

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