Journal
ANTIBIOTICS-BASEL
Volume 11, Issue 7, Pages -Publisher
MDPI
DOI: 10.3390/antibiotics11070846
Keywords
acute respiratory tract infection; antimicrobial stewardship; COVID-19; antimicrobial resistance
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At the start of the COVID-19 pandemic, there was a concern for the misuse of antibiotics in the treatment of CA-ARI. This study demonstrates that modifying the stewardship approach and using a procalcitonin-guided strategy can effectively reduce the duration of antibiotic therapy and curb antibiotic misuse.
At the start of the COVID-19 pandemic, there was an increase in the use of antibiotics for the treatment of community-acquired respiratory tract infection (CA-ARI) in patients admitted for suspected or confirmed COVID-19, raising concerns for misuse. These antibiotics are not under the usual purview of the antimicrobial stewardship unit (ASU). Serum procalcitonin, a biomarker to distinguish viral from bacterial infections, can be used to guide antibiotic recommendations in suspected lower respiratory tract infection. We modified our stewardship approach, and used a procalcitonin-guided strategy to identify high yield interventions for audits in patients admitted with CA-ARI. With this approach, there was an increase in the proportion of patients with antibiotics discontinued within 4 days (16.5% vs. 34.9%, p < 0.001), and the overall duration of antibiotic therapy was significantly shorter [7 (6-8) vs. 6 (3-8) days, p < 0.001]. There was a significant decrease in patients with intravenous-to-oral switch of antibiotics to complete the course (45.3% vs. 34.4%, p < 0.05). Of the patients who had antibiotics discontinued, none were restarted on antibiotics within 48 h, and there was no-30-day readmission or 30-day mortality attributed to respiratory infection. This study illustrates the importance of the antimicrobial stewardship during the pandemic and the need for ASU to remain attuned to prescriber's practices, and adapt accordingly to address antibiotic misuse to curb antimicrobial resistance.
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