COVID-19 could derail antibiotic stewardship efforts

An under-the-radar consequence that the novel coronavirus pandemic (COVID-19) may bring is the spike in inappropriate antibiotic prescriptions, particularly in urgent care and emergency departments, according to a new study presented at the recently concluded 2020 IDWeek Virtual Conference (ID Week 2020).

The pandemic may undo or undermine any existing programmes established to improve antibiotic stewardship in hospitals.

In September 2019, the University of Washington Medicine, Valley Medical Centre, implemented the MITIGATE toolkit, designed to help reduce the rates of antibiotic prescriptions for viral respiratory infections. In the present observational investigation, the researchers sought to determine the impacts of COVID-19 on this intervention.

They found that between January to April this year, the rate of inappropriate antibiotic prescriptions was 7 percent, down from 12 percent during the same months in the previous year. [ID Week 2020, abstract 897587]

This could be attributed to the various mechanisms set in place by the MITIGATE toolkit. By September 2019, for example, medical practitioners in the urgent care department started receiving monthly feedback regarding the prescription practices. At the same time, providers and patients received education about proper antibiotic use, and the best-performing prescribers were lauded.

Monthly feedback for medical providers in the emergency department and primary care only started in January 2020. By February 2020, however, the hospital recorded its first COVID-19 patient, and a month later, shelter-in-place orders had been put into force. As a result, in-person visits to the hospital were limited, and telemedicine consults increased. Due to pandemic-related restrictions, the personalized feedback mechanisms had to be also put on hold.

“The pandemic led to the suspension of individual prescribing feedback and raised concerns for sustainability without ongoing programmatic involvement,” they said.

A surge in antibiotic prescriptions for viral respiratory infections was recorded. In the emergency department, inappropriate prescription rose from a low of approximately 11 percent in the months following the lockdown order to a peak of around 17 percent in June. In the urgent care, this spike occurred almost immediately, with prescription rates more than doubling from 3.6 percent in March to 7.8 percent in April. In comparison, rates remained relatively stable in primary care.

By August, antibiotic prescriptions for viral infections were on the rise in both urgent and primary care, while it showed a downward trend in the emergency department.

“Rates of inappropriate antibiotic prescribing were reduced [by] nearly half from 2019 to 2020 across three ambulatory care settings,” the researchers said. However, “the increase in prescribing in April seen in urgent care and after providers stopped receiving their monthly feedback is concerning.”

“Many factors may have contributed to this increase, but it raises concerns for increased inappropriate antibacterial usage as a side effect of the SARS-CoV-2 pandemic,” they noted.