Role of Antimicrobial Stewardship in Modulating Antibiotic Use and Mitigating Bacterial Resistance in a Tertiary Care Setting During COVID-19.

Abstract

Purpose: Despite the widespread adoption of antimicrobial stewardship (AMS) programs, their effectiveness varies because of differing regional policies and socioeconomic factors. This study aimed to assess the impact of AMS at a Chinese tertiary care hospital on inpatient antimicrobial use and bacterial resistance during the COVID-19 outbreak.

Methods: An interrupted time-series regression analysis was conducted to compare inpatient antimicrobial use between pre- and post-intervention periods. The Chi-squared test and linear regression analysis were used to compare bacterial resistance and illustrate temporal trends in bacterial resistance, respectively.

Results: Following the AMS strategy implementation, we observed a significant decrease in antimicrobial consumption at unrestricted (β2 = -6.38, P = 0.004), restricted (β2 = -17.81, P < 0.001), and special levels (β2 = -2.32, P < 0.001). Despite a reduction in the use of third-generation cephalosporins and macrolides (β2 = -6.85, P < 0.001; β2 = -2.82, P < 0.001), an increase in the trend of use was observed post-intervention (β3 = 0.15, P < 0.001; β3 = 0.04, P = 0.001). Methicillin resistance in Staphylococcus aureus significantly decreased (β = -0.23, P < 0.001) from 52.85% to 40.92%. Conversely, the prevalence of carbapenem-resistant Klebsiella pneumonia increased from 4.69% to 10.87% (P < 0.001), whereas resistance to Acinetobacter baumannii and Pseudomonas aeruginosa marginally decreased (P<0.05). We observed decreases in the antimicrobial utilization rate (β2 = -11.86, P = 0.003) and combination utilization rate (β2 = -12.36, P = 0.011) post-intervention. No significant changes in special-level antimicrobial and prophylactic agent use in category I incisional surgeries were observed.

Conclusion: An AMS program in a Chinese tertiary facilitated effective management of antimicrobial use and reduction of bacterial resistance during the COVID-19 pandemic, in the context of combined infection prevention and control measures. The findings provide useful insights for the implementation of antimicrobial stewardship in future public health crises.