Experts worry antibiotic resistance may be worsening during COVID-19

At the same time, front-line clinicians who aren’t specialists in critical care have been asked to step in and help. Those caregivers aren’t as familiar with respiratory tract infections and protocols in place for antibiotic use, Cosgrove said.

Joint Commission surveys of hospitals for accreditation, which involve reviewing antibiotic stewardship programs, have dropped during the pandemic. Dr. Tim Sorg, an infectious disease physician and surveyor, said he’s concerned that staff have been taken away from stewardship to help with COVID-19 response. “Those folks are probably being pulled in different directions because of this crisis, so there is probably lesser focus on antimicrobial stewardship,” he said.

Johns Hopkins found COVID-19 units staffed with hospitalists had a higher level of antibiotic prescribing compared with COVID-19 units staffed with infectious disease specialists.

Although there are reasons to be concerned about antibiotic resistance during COVID-19, Greg Frank, director of the coalition Working to Fight AMR, said there is some evidence from the federal government that the decline in surgeries and other routine services helped offset the high use of antibiotics on COVID patients because the drugs weren’t being used for other conditions.

Institutions with robust COVID-19 testing and strong antibiotic stewardship programs have likely been able to make progress on inappropriate prescribing since March, Stevens said.

VCU Health experienced an uptick of antibiotic use for pneumonia during the initial weeks of the pandemic, but by May it decreased. The shift coincided with a policy in late April requiring universal COVID-19 screening at the time of admission, Stevens said. VCU also maintained antibiotic stewardship practices including consulting with patients and enforcing antibiotic treatment guidelines.

Since Cosgrove and her team returned to antimicrobial stewardship duties, an evaluation has been done on every COVID-19 patient admitted during the initial months of the pandemic. They found that the bacterial co-infection rate hovered around 1% to 3%. That information has been helpful to front-line caregivers because they know a COVID-19 patient is unlikely to need antibiotics, Cosgrove said.

“Just being able to get that information and create a feedback loop, which is regular stewardship, has been helpful,” she said.

Considering the impact stewardship staff has had response to COVID-19, she cautioned against eyeing cuts to those units for cost savings, saying, “We are pretty good to have around.”