Impact of COVID-19 on AMS

Since first identified in 2019, the coronavirus disease (COVID-19) pandemic has overwhelmed healthcare systems across the globe. The long-term impact of COVID-19 on antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) has been a subject of debate amongst the scientific community.

Following the pandemic, there was a greater awareness and use of protective equipment, social distancing measures, hygiene, and sanitisation. However, a wide portion of resources were reallocated to the pandemic, for example, isolation rooms were prioritised for COVID-19 patients over those with multi-drug resistant organisms and many infectious disease and microbiology teams were repurposed towards managing complex COVID-19 patients.

A previous study set out to measure the impact of COVID-19 on AMS by conducting a questionnaire with AMS leads. 64% of respondents reported a negative effect, with the majority reporting a reduction in AMS activity. You can read the full study here.

In this section, our educator Dr Nusrat Shafiq from the Postgraduate Institute of Medical Education and Research provides their professional account of the impact of COVID-19 on AMS.

The key underlying factors to be aware of when considering these impacts are misinformation, atmosphere of fear, logistics of preventing hospital-acquired infections, and the incorrect use of steroids.

There remains very few examples of AMS programs taking a lead in checking the appropriate use of antimicrobials.

Impacts of COVID-19 on AMS

The circulation of poor-quality evidence, pre-prints, and studies are significant when considering the impact of COVID-19 on AMS. Some examples of this include azithromycin’s potential benefit as a therapeutic agent, and hydroxychloroquine’s role in prophylaxis.

This is particularly important in communities where infections such as community-acquired pneumonia (due to enteric fever or scrub typhus) are prevalent and diagnostics are not readily available. In these cases, the empiric use of antimicrobials was widely increased.

Healthcare facilities with limited staff and logistics due to the infection prevention methods for COVID-19 reported increased opportunities of breeches in infection prevention for hospital acquired infections. This led to the increased use of ‘reserve’ antibiotics, especially if the condition of the patient warranted a long stay.

The indiscriminate and incorrect use of steroids increased the chances of infection, including fungal infections. The fear of this was an important driver for the use of antimicrobials, including antifungals. In the absence of AMS programs, either not existing or operating in a compromised manner, such treatment continued for a prolonged duration without de-escalation and compromised attention to source control.

Furthermore, a culture of malpractice in medical care was a great driver in encouraging ‘package prescriptions.’ This often included a ‘cocktail’ of antibiotics besides other drugs, diagnosing the condition as enteric based on unvalidated Widal testing.

In some parts of the world where migrations of daily wagers took place, the attendance for direct observed therapy or diagnostic screening programs – specifically for TB, Sexually Transmitted Diseases, and HIV – took a hit. These impacts have only been evaluated sporadically. However, it is known that the lack of timely treatment, or interrupted treatment, has high chances of increased prevalence of infections due to resistant organisms warranting reserving antimicrobials.

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