Advice for antibiotics, use of diagnostics in an epidemic

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In a statement released Wednesday at Infection control and hospital epidemiologySHEA provided strategies for hospitals and healthcare workers to improve antibiotic prescribing when they encounter new infectious disease outbreaks.


A society representing more than 2,000 physicians and other healthcare professionals, SHEA further described the circumstances in which an antibiotic should be considered in a respiratory viral outbreak and outlined when diagnostic tests are appropriate.


“This statement addresses the inappropriate prescribing of antibiotics occurring during the coronavirus disease 2019 (COVID-19) pandemic that has exacerbated another pressing public health crisis: antibiotic resistance in bacterial and fungal pathogens,” the authors wrote. .


According to health experts, the problem of antimicrobial resistance has been exacerbated by the unnecessary prescription of antibiotics during the pandemic; using antibiotics when they are not needed leads to the growth of resistant bacteria that are difficult to treat.


SHEA noted that a national report found that 80% of patients hospitalized during the first six months of the COVID-19 pandemic were prescribed antibiotics on admission, even though the drugs were rarely indicated at this time. -the.


“The COVID-19 pandemic highlights the human desire of healthcare workers to intervene, particularly when a patient is critically ill, which can lead to a suspension of evidence-based medicine at the bedside,” said SHEA in his report.


Uncertainty about the diagnosis of COVID-19 has been accompanied by a desire to help patients, concerns about bacterial co-infections, and misleading results from a variety of diagnostic tests to aid in the increased overuse of antibiotics early in the pandemic, the statement said.


“The COVID-19 pandemic is full of lessons for future viral pandemics,” said Dr. Tamar Barlam, lead author of the paper and chair of the SHEA Antimicrobial Stewardship Committee. “The overuse of antibiotics seen in the pandemic points to the need to strengthen antibiotic stewardship programs, so they are well placed to provide guidance across disciplines.”


Diagnostic tests


The published statement provided recommendations on whether to use certain types of diagnostic tests to determine whether patients should be admitted to hospital. Among their recommendations, the authors said healthcare workers “can test for inflammatory markers at baseline, especially in critically ill patients, including C-reactive protein, lactate dehydrogenase, D-dimers, serum ferritin and high-sensitivity troponin”.


However, such personnel should only repeat laboratory tests when they can provide actionable clinical data.


They should not use inflammatory markers as a basis for initiating antibiotics or antifungal agents, according to the report, because such markers may not be indicative of bacterial or fungal co-infection.


Moreover, procalcitonin should not be used systematically to help in the decision to initiate antibiotic therapy.


“Although procalcitonin (PCT) is a biomarker that differentiates viral and bacterial pneumonias in pre-pandemic studies, in COVID-19 it is often a marker of severe disease rather than bacterial co-infection,” wrote the authors.


Healthcare workers “should not obtain bacterial cultures or respiratory multiplex PCR tests for patients who do not show indicators consistent with bacterial infection, especially those clinically stable in a non-ICU setting. “, they added.


SHEA’s advice follows a report by the US Centers for Disease Control and Prevention (CDC) which concluded that antimicrobial resistant infections and hospital deaths increased by at least 15% in the first year. of the pandemic.


“As the pandemic has pushed healthcare facilities, health services and communities close to their breaking points in 2020, we have seen a significant increase in the use of antimicrobials, difficulties in following prevention guidelines and infection control systems, and a resultant increase in healthcare-associated, antimicrobial-resistant infections in U.S. hospitals,” the CDC report states.


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