COVID-19 and antimicrobial stewardship: What is the interplay?

ABSTRACT

[...]antimicrobials are being used in empirical or targeted treatment for co- or superinfection outside the respiratory tract. [...]most data regarding bacterial and fungal respiratory co- and superinfections in the context of a viral respiratory pandemic are derived from previous influenza pandemics,4 and data from previous coronavirus epidemics are limited.5–7 In any case, bacterial and fungal respiratory co- and superinfections during large outbreaks of viral respiratory illnesses are probably underdiagnosed due to a shortage of trained healthcare personnel and/or supplies, infection control requirements, high workload, and the emergent nature of the primary viral disease that make the diagnosis complex and laborious. Data from the current COVID-19 pandemic, in accordance with previous coronavirus epidemics, show that the rate of bacterial and fungal co- or superinfection is relative low, but the use of broad-spectrum antimicrobials is very common.1 Specifically, in the current literature, bacterial and fungal co- and superinfections have been reported in 8% of COVID-19 cases, while 72% of these patients received broad-spectrum antibacterials.1 Finally, in the era of COVID-19, the liberal use of antimicrobials adds an unnecessary risk for possible unfavorable outcomes due to their potential toxicity.8 In addition, their empirical use based on local patterns of resistance has an undetermined probability of failure because during pandemics, significant changes in the pattern of endemic pathogens may evolve.7 Antimicrobial stewardship programs are imperative components of a successful response to COVID-19, and interventions to support the optimal use of antimicrobials are urgently needed. [...]results from further research emerge and stronger evidence is available, the following antimicrobial stewardship strategies should be implemented