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. 2021 Jan 23;10(2):110.
doi: 10.3390/antibiotics10020110.

Assessing the Impact of COVID-19 on Antimicrobial Stewardship Activities/Programs in the United Kingdom

Diane Ashiru-Oredope  1 , Frances Kerr  2 , Stephen Hughes  1 , Jonathan Urch  1 , Marisa Lanzman  1 , Ting Yau  1 , Alison Cockburn  2 , Rakhee Patel  1 , Adel Sheikh  1 , Cairine Gormley  3 , Aneeka Chavda  1 , Tejal Vaghela  1 , Ceri Phillips  4 , Nicholas Reid  4 , Aaron Brady  3
Affiliations

Assessing the Impact of COVID-19 on Antimicrobial Stewardship Activities/Programs in the United Kingdom

Diane Ashiru-Oredope et al. Antibiotics (Basel). .

Abstract

Since first identified in late 2019, the acute respiratory syndrome coronavirus (SARS-CoV2) and the resulting coronavirus disease (COVID-19) pandemic has overwhelmed healthcare systems worldwide, often diverting key resources in a bid to meet unprecedented challenges. To measure its impact on national antimicrobial stewardship (AMS) activities, a questionnaire was designed and disseminated to antimicrobialstewardship leads in the United Kingdom (UK). Most respondents reported a reduction in AMS activity with 64% (61/95) reporting that COVID-19 had a negative impact on routine AMS activities. Activities reported to have been negatively affected by the pandemic include audit, quality improvement initiatives, education, AMS meetings, and multidisciplinary working including ward rounds. However, positive outcomes were also identified, with technology being increasingly used as a tool to facilitate stewardship e.g., virtual meetings and ward rounds and increased the acceptance of using procalcitonin tests to distinguish between viral and bacterial infections. The COVID-19 pandemic has had a significant impact on the AMS activities undertaken across the UK. The long-term impact of the reduced AMS activities on incidence of AMR are not yet known. The legacy of innovation, use of technology, and increased collaboration from the pandemic could strengthen AMS in the post-pandemic era and presents opportunities for further development of AMS.

Keywords: AMR; AMS; COVID-19; SARS-CoV-2; antimicrobial resistance; antimicrobial stewardship; coronavirus.

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Conflict of interest statement

The authors declare no conflict of interest. The organizations the authors of this manuscript have their substantive infection lead roles in are listed: D.A.-O. (Public Health England); F.K. (NHS Lanarkshire, Scotland); S.H. (Chelsea and Westminster Hospital NHS Trust); J.U.(Great Western Hospitals NHS Foundation Trust); M.L. (Royal Free London NHS Foundation Trust); T.Y. (St George’s University Hospitals NHS Foundation Trust); A.C. (Alison Cockburn) (NHS Lothian, Scotland); A.S. (Portsmouth Hospitals University NHS Trust); R.P. (Dartford And Gravesham NHS Trust); C.G. (Western Trust, Northern Ireland); A.C. (Aneeka Chavda) (Imperial College Healthcare NHS Trust); T.V. (West Hertfordshire Hospitals NHS Trust); C.P. (Aneurin Bevan University Health Board, Wales); N.R. (Public Health Wales); A.B. (Queens University, Belfast).

Figures

Figure 1
Figure 1
Impact of coronavirus 2019 (COVID-19) on antimicrobial stewardship (AMS) activities (n = 95 survey respondents).
Figure 2
Figure 2
Changes to AMS initiatives as a result of the COVID-19 surge (n = 95). Key for the Y-axis: Procalcitonin-Start Abx: procalcitonin use to inform starting antibiotics. Procali_NON-ICU-de-escalation: Procalcitonin use in non-intensive care unit (ICU) settings to inform de-escalation and stopping antimicrobial stewardship activity. Procalcitonin_ICU-de-escalation: Procalcitonin use in ICU settings only to inform de-escalation and stopping antimicrobial stewardship activity. Regular SSTF audits: Regular (weekly or monthly) audit of review of antimicrobial prescriptions (Start Smart then Focus principles). CURB65: CURB 65 is specified in the guideline for assessing severity of Community Acquired Pneumonia OxyStats4CAP: Oxygen Saturations is specified in the guideline for assessing severity of Community Acquired Pneumonia. NEWS score for CAP: NEWS2 score is specified in the guideline for assessing severity of Community Acquired Pneumonia. Other measures, CAP: Other measures specified in the guideline for assessing severity of Community Acquired Pneumonia. Radiological imaging/appearance (X-ray/CT/MRI): Radiological imaging/appearance (X-ray/CT/MRI) to facilitate antibiotic review (de-escalating or stopping antibiotic) Amended guideline pre NICE: Amended antimicrobial prescribing guidance for COVID19 (pre NICE Guidance publications).
Figure 3
Figure 3
Percentage of organizations that reviewed their guidelines (n = 95 respondents).
See this image and copyright information in PMC

References

    1. Phelan A.L., Katz R., Gostin L.O. The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance. JAMA J. Am. Med. Assoc. 2020;323:709–710. doi: 10.1001/jama.2020.1097. - DOI - PubMed
    1. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J., Zhao X., Huang B., Shi W., Lu R., et al. A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020;382:727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z., Xiang J., Wang Y., Song B., Gu X., et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395:1054–1062. doi: 10.1016/S0140-6736(20)30566-3. - DOI - PMC - PubMed
    1. Huttner B.D., Catho G., Pano-Pardo J.R., Pulcini C., Schouten J. COVID-19: Don’t neglect antimicrobial stewardship principles! Clin. Microbiol. Infect. 2020;26:808–810. doi: 10.1016/j.cmi.2020.04.024. - DOI - PMC - PubMed
    1. Mazdeyasna H., Nori P., Patel P., Doll M., Godbout E., Lee K., Noda A.J., Bearman G., Stevens M.P. Antimicrobial Stewardship at the Core of COVID-19 Response Efforts: Implications for Sustaining and Building Programs. Curr. Infect. Dis. Rep. 2020;22:1–6. doi: 10.1007/s11908-020-00734-x. - DOI - PMC - PubMed

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