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      The impact of coronavirus disease 2019 (COVID-19) on the antimicrobial stewardship pharmacist workforce: A multicenter survey

      research-article
      Author(s): , PharmD, BCIDP 1 , , PharmD, BCIDP 1 , , , PharmD, BCPS 2 , , MPH 3 , , PharmD, BCIDP 4 , , RPh 5 , , MD 6 , , PharmD, BCPS, BCIDP 7 , , MD, MS 8 , , PharmD, FIDSA, BCIDP 9 , , PharmD 10 , , MD, MHS 11 , , PharmD, BCPS, BCIDP 12 , , PharmD, MPH, BCPS 13 , , RPh, BCPS AQ-ID 10 , , PharmD, BCPS, BCIDP 6 , , MD, MS 3
      Publication date (Electronic, collection):
      Publication date (Electronic):
      Journal: Antimicrobial Stewardship & Healthcare Epidemiology : ASHE
      Publisher: Cambridge University Press

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          Abstract

          Objective:

          The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems and hospitals to rapidly modify standard practice, including antimicrobial stewardship services. Our study examines the impact of COVID-19 on the antimicrobial stewardship pharmacist.

          Design:

          A survey was distributed nationally to all healthcare improvement company members.

          Participants:

          Pharmacist participants were mostly leaders of antimicrobial stewardship programs distributed evenly across the United States and representing urban, suburban, and rural health-system practice sites.

          Results:

          Participants reported relative increases in time spent completing tasks related to medication access and preauthorization (300%; P = .018) and administrative meeting time (34%; P = .067) during the COVID-19 pandemic compared to before the pandemic. Time spent rounding, making interventions, performing pharmacokinetic services, and medication reconciliation decreased.

          Conclusion:

          A shift away from clinical activities may negatively affect the utilization of antimicrobials.

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          Most cited references15

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          Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis

          Bradley Langford, Miranda So, Sumit Raybardhan … (2020)
          Background Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbidity and mortality. The prevalence of bacterial infection in patients infected with SARS-CoV-2 is not well understood. Aims To determine the prevalence of bacterial co-infection (at presentation) and secondary infection (after presentation) in patients with COVID-19. Sources We performed a systematic search of MEDLINE, OVID Epub and EMBASE databases for English language literature from 2019 to April 16, 2020. Studies were included if they (a) evaluated patients with confirmed COVID-19 and (b) reported the prevalence of acute bacterial infection. Content Data were extracted by a single reviewer and cross-checked by a second reviewer. The main outcome was the proportion of COVID-19 patients with an acute bacterial infection. Any bacteria detected from non-respiratory-tract or non-bloodstream sources were excluded. Of 1308 studies screened, 24 were eligible and included in the rapid review representing 3338 patients with COVID-19 evaluated for acute bacterial infection. In the meta-analysis, bacterial co-infection (estimated on presentation) was identified in 3.5% of patients (95%CI 0.4–6.7%) and secondary bacterial infection in 14.3% of patients (95%CI 9.6–18.9%). The overall proportion of COVID-19 patients with bacterial infection was 6.9% (95%CI 4.3–9.5%). Bacterial infection was more common in critically ill patients (8.1%, 95%CI 2.3–13.8%). The majority of patients with COVID-19 received antibiotics (71.9%, 95%CI 56.1 to 87.7%). Implications Bacterial co-infection is relatively infrequent in hospitalized patients with COVID-19. The majority of these patients may not require empirical antibacterial treatment.
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            Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study

            Carolina Garcia-Vidal, Gemma Sanjuan, Estela Moreno-García … (2020)
            Objectives To describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods We performed an observational cohort study of all consecutive patients admitted for ≥48 hours to the Hospital Clinic of Barcelona for COVID-19 (28 February to 22 April 2020) who were discharged or dead. We describe demographic, epidemiologic, laboratory and microbiologic results, as well as outcome data retrieved from electronic health records. Results Of a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74 were bacterial, seven fungal and seven viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31/989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus. A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli, were diagnosed in 43 patients (4.7%), with a mean (SD) time from hospital admission to superinfection diagnosis of 10.6 (6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections had worse outcomes. Conclusions Co-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalization. These findings are different compared to those of other viral pandemics. As it relates to hospitalized patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies.
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              The frequency of influenza and bacterial coinfection: a systematic review and meta‐analysis

              Eili Klein, Bradley Monteforte, Alisha Gupta … (2016)
              Aim Coinfecting bacterial pathogens are a major cause of morbidity and mortality in influenza. However, there remains a paucity of literature on the magnitude of coinfection in influenza patients. Method A systematic search of MeSH, Cochrane Library, Web of Science, SCOPUS, EMBASE, and PubMed was performed. Studies of humans in which all individuals had laboratory confirmed influenza, and all individuals were tested for an array of common bacterial species, met inclusion criteria. Results Twenty‐seven studies including 3215 participants met all inclusion criteria. Common etiologies were defined from a subset of eight articles. There was high heterogeneity in the results (I 2  = 95%), with reported coinfection rates ranging from 2% to 65%. Although only a subset of papers were responsible for observed heterogeneity, subanalyses and meta‐regression analysis found no study characteristic that was significantly associated with coinfection. The most common coinfecting species were Streptococcus pneumoniae and Staphylococcus aureus, which accounted for 35% (95% CI, 14%–56%) and 28% (95% CI, 16%–40%) of infections, respectively; a wide range of other pathogens caused the remaining infections. An assessment of bias suggested that lack of small‐study publications may have biased the results. Conclusions The frequency of coinfection in the published studies included in this review suggests that although providers should consider possible bacterial coinfection in all patients hospitalized with influenza, they should not assume all patients are coinfected and be sure to properly treat underlying viral processes. Further, high heterogeneity suggests additional large‐scale studies are needed to better understand the etiology of influenza bacterial coinfection.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Antimicrob Steward Healthc Epidemiol
                Journal ID (iso-abbrev): Antimicrob Steward Healthc Epidemiol
                Journal ID (publisher-id): ASH
                Title: Antimicrobial Stewardship & Healthcare Epidemiology : ASHE
                Publisher: Cambridge University Press (New York, USA )
                ISSN (Electronic): 2732-494X
                Publication date (Electronic, collection): 2022
                Publication date (Electronic): 07 April 2022
                Volume: 2
                Issue: 1
                Electronic Location Identifier: e56
                Affiliations
                [ 1 ]Department of Pharmacy, University of Wisconsin Health , Madison, Wisconsin
                [ 2 ]Department of Pharmacy, Sentara Healthcare , Norfolk, Virginia
                [ 3 ]Department of Emergency Medicine, University of Wisconsin Madison , Madison, Wisconsin
                [ 4 ]Department of Pharmacy, University of Utah Health , Salt Lake City, Utah
                [ 5 ] University of Kentucky Healthcare , Lexington, Kentucky
                [ 6 ] University of New Mexico Hospital , Albuquerque, New Mexico
                [ 7 ]Department of Pharmacy, Penn State Health Milton S. Hershey Medical Center , Hershey Pennsylvania
                [ 8 ] Stanford University School of Medicine , Stanford, California
                [ 9 ] University of Washington , Seattle, Washington
                [ 10 ]Department of Pharmacy, Northwestern Memorial Hospital , Chicago, Illinois
                [ 11 ] University of Utah Health , Salt Lake City, Utah
                [ 12 ] Barnes-Jewish Healthcare , St Louis, Missouri
                [ 13 ] Harris Health System , Houston Texas
                Author notes
                Author for correspondence: Lucas T. Schulz, PharmD, BCIDP, Department of Pharmacy, University of Wisconsin Health , Rennebohm Hall, 777 Highland Avenue, Madison, WI 53705. E-mail: lschulz2@ 123456uwhealth.org
                Author information
                https://orcid.org/0000-0001-6587-5439
                https://orcid.org/0000-0002-6208-5703
                https://orcid.org/0000-0002-7585-1809
                https://orcid.org/0000-0001-5553-6775
                https://orcid.org/0000-0001-5809-4060
                Article
                Publisher ID: S2732494X22000377
                DOI: 10.1017/ash.2022.37
                PMC ID: 9726570
                SO-VID: 36ce0693-1f74-483a-a81a-e627b081cc10
                Copyright © © The Author(s) 2022
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                Date received : 17 November 2021
                Date revision received : 18 February 2022
                Date accepted : 21 February 2022
                Page count
                Tables: 4, References: 15, Pages: 5
                Categories
                Subject: Original Article

                Data availability:

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