Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Public Health

Background:

• Increased antibiotic use for community-acquired respiratory tract infections (CA-ARI) during the COVID-19 pandemic raised concerns about antimicrobial misuse.
• Antibiotics for CA-ARI in COVID-19 patients were often outside the usual scope of antimicrobial stewardship units (ASUs).
• Serum procalcitonin is a biomarker useful for differentiating viral from bacterial infections, guiding antibiotic therapy.

Purpose of the Study:

• To modify the antimicrobial stewardship approach during the pandemic.
• To implement a procalcitonin-guided strategy for auditing antibiotic use in CA-RI patients.
• To identify high-yield interventions to reduce antibiotic misuse and curb antimicrobial resistance.

Main Methods:

• Modified the antimicrobial stewardship approach by incorporating a procalcitonin-guided strategy.
• Conducted audits on patients admitted with CA-ARI, focusing on high-yield interventions.
• Analyzed antibiotic discontinuation rates, duration of therapy, and intravenous-to-oral switch.

Main Results:

• Increased proportion of patients with antibiotics discontinued within 4 days (16.5% vs. 34.9%, p < 0.001).
• Significantly shorter overall antibiotic therapy duration [7 (6–8) vs. 6 (3–8) days, p < 0.001].
• Decreased intravenous-to-oral switch for completing antibiotic courses (45.3% vs. 34.4%, p < 0.05), with no antibiotic restarts or 30-day respiratory infection-related mortality.

Conclusions:

• Antimicrobial stewardship is crucial during pandemics, requiring ASUs to adapt to prescriber practices.
• A procalcitonin-guided strategy effectively reduced antibiotic misuse in CA-RI patients during the COVID-19 pandemic.
• Adapting stewardship practices is essential to combat antimicrobial resistance.