Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic
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...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/11/7/846 |
| _version_ | 1797407865111052288 |
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| author | Shena Y. C. Lim Yvonne P. Zhou Daphne Yii De Zhi Chin Kai Chee Hung Lai Wei Lee Jia Le Lim Li Wen Loo Narendran Koomanan Nathalie Grace Chua Yixin Liew Benjamin P. Z. Cherng Siew Yee Thien Winnie H. L. Lee Andrea L. H. Kwa Shimin J. Chung |
| author_facet | Shena Y. C. Lim Yvonne P. Zhou Daphne Yii De Zhi Chin Kai Chee Hung Lai Wei Lee Jia Le Lim Li Wen Loo Narendran Koomanan Nathalie Grace Chua Yixin Liew Benjamin P. Z. Cherng Siew Yee Thien Winnie H. L. Lee Andrea L. H. Kwa Shimin J. Chung |
| author_sort | Shena Y. C. Lim |
| collection | DOAJ |
| description | 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%, <i>p</i> < 0.001), and the overall duration of antibiotic therapy was significantly shorter [7 (6–8) vs. 6 (3–8) days, <i>p</i> < 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%, <i>p</i> < 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. |
| first_indexed | 2024-03-09T03:47:53Z |
| format | Article |
| id | doaj.art-def144c4563147aba9946797948074f4 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T03:47:53Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-def144c4563147aba9946797948074f42023-12-03T14:32:25ZengMDPI AGAntibiotics2079-63822022-06-0111784610.3390/antibiotics11070846Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 PandemicShena Y. C. Lim0Yvonne P. Zhou1Daphne Yii2De Zhi Chin3Kai Chee Hung4Lai Wei Lee5Jia Le Lim6Li Wen Loo7Narendran Koomanan8Nathalie Grace Chua9Yixin Liew10Benjamin P. Z. Cherng11Siew Yee Thien12Winnie H. L. Lee13Andrea L. H. Kwa14Shimin J. Chung15Department of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Clinical Quality and Performance Management, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Infectious Diseases, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Infectious Diseases, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Pharmacy, Singapore General Hospital, Singapore 169608, SingaporeDepartment of Infectious Diseases, Singapore General Hospital, Singapore 169608, SingaporeAt 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%, <i>p</i> < 0.001), and the overall duration of antibiotic therapy was significantly shorter [7 (6–8) vs. 6 (3–8) days, <i>p</i> < 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%, <i>p</i> < 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.https://www.mdpi.com/2079-6382/11/7/846acute respiratory tract infectionantimicrobial stewardshipCOVID-19antimicrobial resistance |
| spellingShingle | Shena Y. C. Lim Yvonne P. Zhou Daphne Yii De Zhi Chin Kai Chee Hung Lai Wei Lee Jia Le Lim Li Wen Loo Narendran Koomanan Nathalie Grace Chua Yixin Liew Benjamin P. Z. Cherng Siew Yee Thien Winnie H. L. Lee Andrea L. H. Kwa Shimin J. Chung Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic Antibiotics acute respiratory tract infection antimicrobial stewardship COVID-19 antimicrobial resistance |
| title | Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic |
| title_full | Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic |
| title_fullStr | Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic |
| title_full_unstemmed | Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic |
| title_short | Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic |
| title_sort | stemming the rise of antibiotic use for community acquired acute respiratory infections during covid 19 pandemic |
| topic | acute respiratory tract infection antimicrobial stewardship COVID-19 antimicrobial resistance |
| url | https://www.mdpi.com/2079-6382/11/7/846 |
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