How the COVID-19 Pandemic Affected Antimicrobial Stewardship

Antibiotic use increased inappropriately during the COVID-19 pandemic, fueled by a number of factors, Payal K. Patel, MD, MPH, FIDSA, explained in her talk at the Making a Difference in Infectious Disease (MAD-ID) 2022 annual meeting, held May 18-21, 2022, in Orlando, Florida.

Lack of antimicrobial stewardship programs (ASP), knowledge and dissemination of data, misinformation, diagnostic capabilities, competing demands for ASP, and cognitive bias all contributed to the increase in antibiotic use, Patel, medical director of antimicrobial stewardship at VA Ann Arbor, told Contagion® in a video interview.

Transcript has been edited for length and clarity.

Contagion®: Let’s start off and talk a bit about how the pandemic affected antimicrobial stewardship in general?

Patel: In the US, we saw in the first few months that, like the rest of the world, antibiotic use really increased inappropriately during the pandemic. But I think because of good stewardship work across the US, we were able to curb that really early, whereas it took a lot longer internationally. In my talk, I'm going to talk about some of the reasons why, which include misinformation and of lack of effective stewardship programs.

Contagion®: How did misinformation surrounding the COVID-19 pandemic factor into all of this?

Patel: We're still seeing misinformation [as] a huge issue during the pandemic and, even now, talking about vaccines. But early on in terms of antibiotics, we were seeing people talk about antiparasitics, as well as antibiotics and their efficacy when we knew, as we continued on, that azithromycin and ivermectin didn't work against COVID-19, [yet] there was still this ongoing narrative that was often happening. I often will point people to a couple of websites, trusted websites, [where] I think you can get good information. And one of them is the CDC IDSA COVID-19 Real-Time Learning Network.

Contagion®: And what about diagnostics? That plays a huge part, too, right?

Patel: We all remember early on in those first days where it would take more than a day or 2 to get testing back. And there were a lot of things at that time [that] we didn't know, co-infection rates and all of these things. As those things improved over the first couple of months, that really helped curb inappropriate antibiotic use as well.

Contagion®: If you had to give a rating for how we’re doing now when it comes to inappropriate antibiotic use vs how we were doing at the height of the pandemic, what would it be?

Patel: I think actually, we're finally getting back to a point where we can think about antibiotic stewardship outside of COVID-19. For a while there, all of our efforts were focused in on the pandemic in one way or the other. I think a lot of stewardship programs are finally getting back to some of the work that had unfortunately been put on the shelf for a while. But I think overall, I think we're really lucky in the US to have the government, as well as many patient safety groups, supporting stewardship, and I hope that we continue to see that push worldwide.

Contagion®: You mention the concept of “mindful medicine” in your talk. Can you explain that a bit more?

Patel: The more I think about cognitive bias and how that affects how antibiotic use works, I think really thinking about cognitive biases and being mindful, even on the stewardship side as we think about interventions, may be more effective in the end inside or outside of the pandemic.