Antimicrobial Use and Stewardship during the COVID-19 Era

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 July 2022) | Viewed by 33193

Special Issue Editors

Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
Interests: antimicrobial stewardship; viral hepatitis; HBV; HCV; HIV
Special Issues, Collections and Topics in MDPI journals
Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, 41122 Modena, Italy
Interests: infectious diseases control and prevention; drug resistance; infectious diseases surveillance; infectious diseases transmission
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is well known that the spread of antimicrobial resistance represents one of the most important threats for public health, and the correct use of antibiotics is essential to limit the selection of resistant strains. Several authorities and scientific societies have therefore recommended the implementation of programs to increase the appropriateness of antimicrobial prescriptions. Unfortunately, the SARS-CoV-2 pandemic led to an interruption or limitation of antimicrobial stewardship programs in many settings, mostly due to a reduced availability of dedicated staff and resources. Furthermore, despite the relatively low frequency of microbiologically documented bacterial co-infections in COVID-19 patients, many studies have reported a rate of antibiotic prescriptions ranging from 60% up to 85% in this population, mostly involving broad-spectrum molecules. Conversely, the limited access to primary care or outpatient clinics has been related in some reports to a reduced antibiotic consumption in non-hospitalized patients.

This Special Issue of Antibiotics seeks the submission of manuscripts aiming to increase our knowledge regarding the impact of the COVID-19 pandemic on the antibiotic prescription behavior of physicians (both in COVID-19 and non-COVID-19 patients), as well as the changes that have occurred during the pandemic in the stewardship strategies and their consequences on the antimicrobial resistance patterns both in hospital and outpatient settings.

Dr. Lorenzo Onorato
Dr. Marianna Meschiari
Guest Editors

Manuscript Submission Information

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Keywords

  • antimicrobial stewardship
  • COVID-19
  • SARS-CoV-2
  • antimicrobial resistance
  • antibiotic prescriptions

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Published Papers (10 papers)

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12 pages, 1487 KiB  
Article
Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China
by Bingbing Zhu, Xinping Zhao, Yurong Li, Na Wang, Helen Lambert, Fei Yan, Qingwu Jiang and Chaowei Fu
Antibiotics 2022, 11(11), 1544; https://doi.org/10.3390/antibiotics11111544 - 03 Nov 2022
Cited by 2 | Viewed by 1350
Abstract
There are growing concerns that the coronavirus disease of 2019 (COVID-19) pandemic may change antibiotic use patterns and accelerate antibiotic resistance, but evidence from the community level is lacking. This study aims to estimate the impact of the COVID-19 outbreak on the antibiotic [...] Read more.
There are growing concerns that the coronavirus disease of 2019 (COVID-19) pandemic may change antibiotic use patterns and accelerate antibiotic resistance, but evidence from the community level is lacking. This study aims to estimate the impact of the COVID-19 outbreak on the antibiotic use patterns among a community population in Eastern China. A self-administered medicine diary was used to collect information on antibiotic use from July 2019 to June 2021 among a rural community in Eastern China. We analyzed the changes in antibiotic use patterns over five months from August to December 2019 and the corresponding months in 2020. The risk of antibiotic use and its changes were measured with the incidence rate (IR) and relative risk (RR). In total, 1111 participants were eligible for the final analysis (440 in 2019 and 671 in 2020). After the COVID-19 outbreak, antibiotic use increased by 137% (5.43 per 100 person months in the 2019 vs. 12.89 per 100 person months in the 2020), and after the adjustment of covariates, the adjusted RR was 1.72 (95% CI: 1.10~2.34). It was higher among those who were women (RR = 2.62), aged 35–59 years old (RR = 2.72), non-farmers (RR = 2.75), had less than six years of education (RR = 2.61), had an annual household income over CNY 100,000 (USD 14,940) (RR = 2.60), and had no history of chronic diseases (RR = 2.61) (all p < 0.05). The proportion of cephalosporins consumed increased from 54.29% in 2019 to 64.92% in 2020 (p = 0.011). Among those aged 35 years and older, the proportion of antibiotics obtained from medical facilities increased, while the proportion obtained from retail pharmacies, homes, and other sources decreased (all p < 0.05). The COVID-19 outbreak changed antibiotic use patterns in this study population (Eastern China) significantly. More efforts to monitor and enhance antibiotic stewardship activities at the community level are needed in future. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
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10 pages, 1399 KiB  
Article
Impact of the COVID-19 Pandemic on Antibiotic Prescribing by Dentists in Galicia, Spain: A Quasi-Experimental Approach
by Almudena Rodríguez-Fernández, Olalla Vázquez-Cancela, María Piñeiro-Lamas, Adolfo Figueiras and Maruxa Zapata-Cachafeiro
Antibiotics 2022, 11(8), 1018; https://doi.org/10.3390/antibiotics11081018 - 29 Jul 2022
Cited by 3 | Viewed by 1623
Abstract
Background: Antibiotic resistance is one of the most pressing public health problems. Health authorities, patients, and health professionals, including dentists, are all involved in its development. COVID-19 pandemic restrictions on dental care may have had repercussions on antibiotic prescribing by dentists. The aim [...] Read more.
Background: Antibiotic resistance is one of the most pressing public health problems. Health authorities, patients, and health professionals, including dentists, are all involved in its development. COVID-19 pandemic restrictions on dental care may have had repercussions on antibiotic prescribing by dentists. The aim of this study was to assess the impact of the COVID-19 pandemic on antibiotic prescribing by dentists, and to review antibiotic consumption according to the WHO Access, Watch, Reserve classification. We conducted a natural, before-and-after, quasi-experimental study, using antibiotic prescription data covering the period from January 2017 to May 2021. A segmented regression analysis with interrupted time series data was used to analyse the differences between the numbers of defined daily doses (DDD) of antibiotics prescribed monthly. The outcomes showed an immediate significant decrease in overall antibiotic prescribing by primary-care dentists during lockdown, followed by a non-significant upward trend for the next year. This same pattern was, likewise, observed for Access and Watch antibiotics. COVID-19 pandemic restrictions on dental care influenced the prescription of antibiotics. During confinement, an initial decrease was observed, this trend changed when in person consultations were recovered. It might be beneficial to analyse the prescription of antibiotics using the WHO AWaRe classification, in order to monitor their appropriate use. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
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13 pages, 1086 KiB  
Article
Long-Term Impact of the COVID-19 Pandemic on In-Hospital Antibiotic Consumption and Antibiotic Resistance: A Time Series Analysis (2015–2021)
by Marianna Meschiari, Lorenzo Onorato, Erica Bacca, Gabriella Orlando, Marianna Menozzi, Erica Franceschini, Andrea Bedini, Adriana Cervo, Antonella Santoro, Mario Sarti, Claudia Venturelli, Emanuela Biagioni, Irene Coloretti, Stefano Busani, Massimo Girardis, José-María Lòpez-Lozano and Cristina Mussini
Antibiotics 2022, 11(6), 826; https://doi.org/10.3390/antibiotics11060826 - 20 Jun 2022
Cited by 20 | Viewed by 3699
Abstract
The coronavirus disease 2019 (COVID-19)-pandemic-related overload of health systems has compromised the application of antimicrobial stewardship (AS) models and infection prevention and control (IPC) programs. We aimed to evaluate the impact of COVID-19 on antimicrobial consumption (AC) and antimicrobial resistance (AMR) in the [...] Read more.
The coronavirus disease 2019 (COVID-19)-pandemic-related overload of health systems has compromised the application of antimicrobial stewardship (AS) models and infection prevention and control (IPC) programs. We aimed to evaluate the impact of COVID-19 on antimicrobial consumption (AC) and antimicrobial resistance (AMR) in the University Hospital of Modena. A time series analysis with an autoregressive integrated moving average model was conducted from January 2015 to October 2021 to evaluate the AC in the whole hospital and the intensive care unit (ICU), the incidence density (ID) of bloodstream infections (BSIs) due to the main multidrug-resistant organisms, and of C. difficile infections (CDIs). After an initial peak during the COVID-19 period, a decrease in the trend of AC was observed, both at the hospital (CT: −1.104, p = 0.025) and ICU levels (CT: −4.47, p = 0.047), with no significant difference in the single classes. Among the Gram-negative isolates, we observed a significant increase only in the level of BSIs due to carbapenem-susceptible Pseudomonas aeruginosa (CL: 1.477, 95% CI 0.130 to 2.824, p = 0.032). Considering Gram-positive bacteria, an increase in the level of BSIs due to methicillin-resistant Staphylococcus aureus and in the trend of CDIs were observed, though they did not reach statistical significance (CL: 0.72, 95% CI −0.039 to 1.48, p = 0.062; CT: 1.43, 95% CI −0.002 to 2.863, p = 0.051; respectively). Our findings demonstrated that the increases in AMR and AC that appeared in the first COVID-19 wave may be later controlled by restoring IPC and AS programs to pre-epidemic levels. A coordinated healthcare effort is necessary to address the longer-term impact of COVID-19 on AC to avoid irreversible consequences on AMR. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
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12 pages, 960 KiB  
Article
Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients
by Naveed Ahmed, Madiha Khan, Waqas Saleem, Mohmed Isaqali Karobari, Roshan Noor Mohamed, Artak Heboyan, Ali A. Rabaan, Abbas Al Mutair, Saad Alhumaid, Salman A. Alsadiq, Ahmed S. Bueid, Eman Y. Santali and Jeehan H. Alestad
Antibiotics 2022, 11(2), 276; https://doi.org/10.3390/antibiotics11020276 - 19 Feb 2022
Cited by 24 | Viewed by 5338
Abstract
In addition to the pathogenesis of SARS-CoV-2, bacterial co-infection plays an essential role in the incidence and progression of SARS-CoV-2 infections by increasing the severity of infection, as well as increasing disease symptoms, death rate and antimicrobial resistance (AMR). The current study was [...] Read more.
In addition to the pathogenesis of SARS-CoV-2, bacterial co-infection plays an essential role in the incidence and progression of SARS-CoV-2 infections by increasing the severity of infection, as well as increasing disease symptoms, death rate and antimicrobial resistance (AMR). The current study was conducted in a tertiary-care hospital in Lahore, Pakistan, among hospitalized COVID-19 patients to see the prevalence of bacterial co-infections and the AMR rates among different isolated bacteria. Clinical samples for the laboratory diagnosis were collected from 1165 hospitalized COVID-19 patients, of which 423 were found to be positive for various bacterial infections. Most of the isolated bacteria were Gram-negative rods (n = 366), followed by Gram-positive cocci (n = 57). A significant association (p < 0.05) was noted between the hospitalized COVID-19 patients and bacterial co-infections. Staphylococcus aureus (S. aureus) showed high resistance against tetracycline (61.7%), Streptococcus pyogenes against penicillin (100%), E. coli against Amp-clavulanic acid (88.72%), Klebsiella pneumoniae against ampicillin (100%), and Pseudomonas aeruginosa against ciprofloxacin (75.40%). Acinetobacter baumannii was 100% resistant to the majority of tested antibiotics. The prevalence of methicillin-resistant S. aureus (MRSA) was 14.7%. The topmost symptoms of >50% of COVID-19 patients were fever, fatigue, dyspnea and chest pain with a significant association (p < 0.05) in bacterial co-infected patients. The current study results showed a comparatively high prevalence of AMR, which may become a severe health-related issue in the future. Therefore, strict compliance of antibiotic usage and employment of antibiotic stewardship programs at every public or private institutional level are recommended. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
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12 pages, 3490 KiB  
Article
The Usage of Antibiotics by COVID-19 Patients with Comorbidities: The Risk of Increased Antimicrobial Resistance
by Basit Zeshan, Mohmed Isaqali Karobari, Nadia Afzal, Amer Siddiq, Sakeenabi Basha, Syed Nahid Basheer, Syed Wali Peeran, Mohammed Mustafa, Nur Hardy A. Daud, Naveed Ahmed, Chan Yean Yean and Tahir Yusuf Noorani
Antibiotics 2022, 11(1), 35; https://doi.org/10.3390/antibiotics11010035 - 29 Dec 2021
Cited by 25 | Viewed by 3439
Abstract
Antimicrobial resistance (AMR) is a global health issue that plays a significant role in morbidity and mortality, especially in immunocompromised patients. It also becomes a serious threat to the successful treatment of many bacterial infections. The widespread and irrelevant use of antibiotics in [...] Read more.
Antimicrobial resistance (AMR) is a global health issue that plays a significant role in morbidity and mortality, especially in immunocompromised patients. It also becomes a serious threat to the successful treatment of many bacterial infections. The widespread and irrelevant use of antibiotics in hospitals and local clinics is the leading cause of AMR. Under this scenario, the study was conducted in a tertiary care hospital in Lahore, Pakistan, from 2 August 2021 to 31 October 2021 to discover the prevalence of bacterial infections and AMR rates in COVID-19 patients admitted in surgical intensive care units (SICUs). Clinical samples were collected from the patients and we proceeded to identify bacterial isolates, followed by antibiotic susceptibility testing (AST) using the Kirby Bauer disk diffusion method and minimum inhibitory concentration (MIC). The data of other comorbidities were also collected from the patient’s medical record. The current study showed that the most common pathogens were E. coli (32%) and Klebsiella pneumoniae (17%). Most E. coli were resistant to ciprofloxacin (16.8%) and ampicillin (19.8%). Klebsiella pneumoniae were more resistant to ampicillin (13.3%) and amoxycillin (12.0%). The most common comorbidity was chronic kidney disease (CKD) and urinary tract infections (UTIs). Around 17 different types of antibiotic, the carbapenem, fluoroquinolones, aminoglycoside, and quinolones, were highly prevalent in ICU patients. The current study provides valuable data on the clinical implication of antibiotics consumed by COVID-19 patients in SICUs and the AMR rates, especially with different comorbidities. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
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12 pages, 762 KiB  
Article
Procalcitonin Increase Is Associated with the Development of Critical Care-Acquired Infections in COVID-19 ARDS
by Owen Richards, Philip Pallmann, Charles King, Yusuf Cheema, Charlotte Killick, Emma Thomas-Jones, Jessica Harris, Catherine Bailey and Tamas Szakmany
Antibiotics 2021, 10(11), 1425; https://doi.org/10.3390/antibiotics10111425 - 22 Nov 2021
Cited by 18 | Viewed by 2799
Abstract
Secondary bacterial infection in COVID-19 patients is associated with increased mortality and disproportionately affects critically ill patients. This single-centre retrospective observational study investigates the comparative efficacy of change in procalcitonin (PCT) and other commonly available biomarkers in revealing or predicting microbiologically proven secondary [...] Read more.
Secondary bacterial infection in COVID-19 patients is associated with increased mortality and disproportionately affects critically ill patients. This single-centre retrospective observational study investigates the comparative efficacy of change in procalcitonin (PCT) and other commonly available biomarkers in revealing or predicting microbiologically proven secondary infection in critical COVID-19 patients. Adult patients admitted to an intensive care unit (ICU) with confirmed SARS-CoV-2 infection between 9 March 2020 and 5 June 2020 were recruited to the study. For daily biomarker and secondary infection, laboratory-confirmed bloodstream infection (LCBI) and ventilator-associated pneumonia/tracheobronchitis (VAP/VAT) data were collected. We observed a PCT rise in 53 (81.5%) of the patients, a C-reactive protein (CRP) rise in 55 (84.6%) and a white blood cell count (WBC) rise in 61 (93.8%). Secondary infection was confirmed in 33 (50.8%) of the patients. A PCT rise was present in 97.0% of patients with at least one confirmed VAP/VAT and/or LCBI event. CRP and WBC rises occurred in 93.9% and 97.0% of patients with confirmed VAP/VAT and/or LCBI, respectively. Logistic regression analysis found that, when including all biomarkers in the same model, there was a significant association between PCT rise and the occurrence of LCBI and/or VAP/VAT (OR = 14.86 95%CI: 2.20, 342.53; p = 0.021). Conversely, no statistically significant relationship was found between either a CRP rise (p = 0.167) or a WBC rise (p = 0.855) and the occurrence of VAP/VAT and/or LCBI. These findings provide a promising insight into the usefulness of PCT measurement in predicting the emergence of secondary bacterial infection in ICU. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
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10 pages, 254 KiB  
Article
The Impact of the SARS-Cov2 Pandemic on a Persuasive Educational Antimicrobial Stewardship Program in a University Hospital in Southern Italy: A Pre-Post Study
by Margherita Macera, Lorenzo Onorato, Federica Calò, Caterina Monari, Rosa Annibale, Giuseppe Signoriello, Giovanna Donnarumma, Maria Vittoria Montemurro, Massimiliano Galdiero and Nicola Coppola
Antibiotics 2021, 10(11), 1405; https://doi.org/10.3390/antibiotics10111405 - 16 Nov 2021
Cited by 7 | Viewed by 1660
Abstract
Objectives: We evaluated the effect of the pandemic on the disruption of a persuasive educational antimicrobial stewardship program (ASP) conducted in a university hospital in southern Italy. Methods: In March 2020, the ASP, which began in January 2017 and was carried out at [...] Read more.
Objectives: We evaluated the effect of the pandemic on the disruption of a persuasive educational antimicrobial stewardship program (ASP) conducted in a university hospital in southern Italy. Methods: In March 2020, the ASP, which began in January 2017 and was carried out at different times in 10 wards, was stopped due to the COVID-19 pandemic. We conducted an observational study with interrupted time series analysis to compare the antibiotic consumption and costs, average length of hospital stay and in-hospital mortality between 12 months before and 9 months after the interruption. Results: Four medical, four surgical wards and two ICUs were included in the study, for a total of 35,921 patient days. Among the medical wards we observed after the interruption a significant increase in fluoroquinolone use, with a change in trend (CT) of 0.996, p = 0.027. In the surgical wards, we observed a significant increase in the overall consumption, with a change in level (CL) of 24.4, p = 0.005, and in the use of third and fourth generation cephalosporins (CL 4.7, p = 0.003). In two ICUs, we observed a significant increase in piperacillin/tazobactam and fluoroquinolone consumption (CT 9.28, p = 0.019, and 2.4, p = 0.047). In the wards with a duration of ASP less than 30 months, we observed a significant increase in antibiotic consumption in the use of piperacillin/tazobactam and fluoroquinolones (CT 12.9, p = 0.022: 4.12, p = 0.029; 1.004, p = 0.011). Conclusions: The interruption of ASP during COVID-19 led to an increase in the consumption of broad-spectrum antibiotics, particularly in surgical wards and in those with a duration of ASP less than 30 months. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
8 pages, 549 KiB  
Article
Use of Procalcitonin during the First Wave of COVID-19 in the Acute NHS Hospitals: A Retrospective Observational Study
by Neil Powell, Philip Howard, Martin J. Llewelyn, Tamas Szakmany, Mahableswhar Albur, Stuart E Bond, Joanne Euden, Lucy Brookes-Howell, Paul Dark, Thomas P Hellyer, Susan Hopkins, Iain J McCullagh, Margaret Ogden, Philip Pallmann, Helena Parsons, David G Partridge, Dominick E. Shaw, Bethany Shinkins, Stacy Todd, Emma Thomas-Jones, Robert West, Enitan D Carrol and Jonathan A. T. Sandoeadd Show full author list remove Hide full author list
Antibiotics 2021, 10(5), 516; https://doi.org/10.3390/antibiotics10050516 - 01 May 2021
Cited by 19 | Viewed by 5692
Abstract
A minority of patients presenting to hospital with COVID-19 have bacterial co-infection. Procalcitonin testing may help identify patients for whom antibiotics should be prescribed or withheld. This study describes the use of procalcitonin in English and Welsh hospitals during the first wave of [...] Read more.
A minority of patients presenting to hospital with COVID-19 have bacterial co-infection. Procalcitonin testing may help identify patients for whom antibiotics should be prescribed or withheld. This study describes the use of procalcitonin in English and Welsh hospitals during the first wave of the COVID-19 pandemic. A web-based survey of antimicrobial leads gathered data about the use of procalcitonin testing. Responses were received from 148/151 (98%) eligible hospitals. During the first wave of the COVID-19 pandemic, there was widespread introduction and expansion of PCT use in NHS hospitals. The number of hospitals using PCT in emergency/acute admissions rose from 17 (11%) to 74/146 (50.7%) and use in Intensive Care Units (ICU) increased from 70 (47.6%) to 124/147 (84.4%). This increase happened predominantly in March and April 2020, preceding NICE guidance. Approximately half of hospitals used PCT as a single test to guide decisions to discontinue antibiotics and half used repeated measurements. There was marked variation in the thresholds used for empiric antibiotic cessation and guidance about interpretation of values. Procalcitonin testing has been widely adopted in the NHS during the COVID-19 pandemic in an unevidenced, heterogeneous way and in conflict with relevant NICE guidance. Further research is needed urgently that assesses the impact of this change on antibiotic prescribing and patient safety. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
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15 pages, 1036 KiB  
Review
Antibiotic Use and Bacterial Infection in COVID-19 Patients in the Second Phase of the SARS-CoV-2 Pandemic: A Scoping Review
by Wenjuan Cong, Beth Stuart, Nour AIhusein, Binjuan Liu, Yunyi Tang, Hexing Wang, Yi Wang, Amit Manchundiya and Helen Lambert
Antibiotics 2022, 11(8), 991; https://doi.org/10.3390/antibiotics11080991 - 23 Jul 2022
Cited by 13 | Viewed by 2240
Abstract
This scoping review aimed to explore the prevalence and patterns of global antibiotic use and bacterial infection in COVID-19 patients from studies published between June 2020 and March 2021. This review was reported in line with the Preferred Reporting of Systematic Reviews and [...] Read more.
This scoping review aimed to explore the prevalence and patterns of global antibiotic use and bacterial infection in COVID-19 patients from studies published between June 2020 and March 2021. This review was reported in line with the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews, and the protocol is registered with the Open Science Framework. Compared with our previously-published review of the period (December 2019–June 2020), the antibiotic prescribing rate for COVID-19 patients (June 2020–March 2021) was found to have declined overall (82.3% vs. 39.7%), for mild and moderate patients (75.1% vs. 15.5%), and for severe and critical patients (75.3% vs. 48.3%). The seven most frequently prescribed antibiotics in COVID-19 patients were all on the “Watch” list of the WHO AWaRe antibiotics classification. The overall reported bacterial infection rate in COVID-19 patients was 10.5%, and the most frequently reported resistant pathogen in COVID-19 patients was Staphylococcus aureus, followed by Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. There is an urgent need to establish comprehensive and consistent guidelines to assist clinicians in selecting appropriate antibiotics for COVID-19 patients when needed. The resistance data on the most frequently used antibiotics for COVID-19 patients for certain resistant pathogens should be closely monitored. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
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9 pages, 242 KiB  
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Inappropriate Antibiotic Use in Zimbabwe in the COVID-19 Era: A Perfect Recipe for Antimicrobial Resistance
by Itai Chitungo, Tafadzwa Dzinamarira, Tinashe K. Nyazika, Helena Herrera, Godfrey Musuka and Grant Murewanhema
Antibiotics 2022, 11(2), 244; https://doi.org/10.3390/antibiotics11020244 - 13 Feb 2022
Cited by 18 | Viewed by 3823
Abstract
The global COVID-19 pandemic has resulted in an upsurge in antimicrobial use. The increase in use is multifactorial, and is particularly related to the empirical treatment of SARS-CoV-2 and suspected coinfections with antimicrobials and the limited quality of diagnostics to differentiate viral and [...] Read more.
The global COVID-19 pandemic has resulted in an upsurge in antimicrobial use. The increase in use is multifactorial, and is particularly related to the empirical treatment of SARS-CoV-2 and suspected coinfections with antimicrobials and the limited quality of diagnostics to differentiate viral and bacterial pneumonia. The lack of clear clinical guidelines across a wide range of settings, and the inadequacy of public health sectors in many countries, have contributed to this pattern. The increased use of antimicrobials has the potential to increase incidences of antimicrobial resistance, especially in low-resource countries such as Zimbabwe already grappling with multidrug-resistant micro-organism strains. By adopting the antimicrobial stewardship principles of the correct prescription and optimised use of antimicrobials, as well as diagnostic stewardship, revamping regulatory oversight of antimicrobial surveillance may help limit the occurrence of antimicrobial resistance during this pandemic. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era)
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