IDSE Review
Complicated Milieu of Issues During COVID-19 Affected Stewardship BY JAMES S. LEWIS II, PHARMD
A
ntibiotic stewardship is a core tenet in hospital and public health as a tool to minimize the emergence of antibacterial resistance.1 Great strides have been made during the past decade to increase awareness of the overuse of antibiotics in medicine. Randomized trials have facilitated a “shorter is better” mindset in medical practice that has allowed for improved antibiotic use in many commonly encountered infections.2 In addition, a variety of other tools and data reporting structures now exist to improve the use of this critical class of medicines.3
Since its arrival in 2020, COVID-19 has created a complicated milieu of issues resulting in a step backward for many antibiotic stewardship programs: Diagnostic uncertainty while managing critically ill patients, the recognition that many moderately ill patients with COVID-19 would need ICU care, and the reemergence of the long-held perception that antibiotics can only help have coalesced around COVID19 patients in the ICU. These issues combined with a new and unknown infectious entity have led clinicians to an uncomfortable space where a patient’s clinical syndrome could be COVID-19; however, it could be a bacterial infection, and providers are very
aware of the deleterious effects of delayed effective antibacterial therapy on bacterial infection–related mortality.4 This scenario affected antibiotic stewardship programs in many clinical settings, as clinicians often were reassigned to assist in the implementation of COVID-19 therapeutic plans and strategies.5 These efforts, while certainly important and worthy of the dedicated resources, have resulted in marked reductions in the time dedicated to antibiotic stewardship rounds and responsibilities. Furthermore, early in the pandemic, there was considerable concern about bacterial superinfections that have historically
INFECTIOUS DISEASE SPECIAL EDITION • SUMMER 2022
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