The Perfect Enemy | Stewardship / Resistance Scan for Nov 04, 2022
December 2, 2022

Stewardship / Resistance Scan for Nov 04, 2022

Procalcitonin and antibiotics in COVID patients
Antibiotic knowledge, use in Egypt
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Procalcitonin trends linked to antibiotic use, duration in COVID-19 patients

A study of hospitalized COVID-19 patients in Michigan found that procalcitonin (PCT) trends were associated with the decision to initiate antibiotics and duration of treatment, independent of bacterial pneumonia (bPNA) status, researchers reported today in Infection Control & Hospital Epidemiology.

The observational study, conducted by researchers with the University of Michigan Medical School, analyzed data on SARS-CoV-2–positive patients hospitalized at Michigan Medicine from March 2020 through October 2021 who had one or more PCT measurement. While PCT levels can be a useful marker for bacterial infections like pneumonia, COVID-19 can raise PCT levels in the absence of bacterial infections, which has raised questions about whether PCT measurements can aid antibiotic stewardship efforts in COVID-19 patients. The primary outcome of the study was the associations of PCT level and bPNA with antibiotic use.

Of 793 patients included in the analysis, 224 (28.2%) were initiated on antibiotics: 33 (14.7%) had proven or probable bPNA, 125 (55.8%) had possible bPNA, and 66 (29.5%) had no bPNA. Patients had a mean of 4.1 (standard deviation [SD], ±5.2) PCT measurements if receiving antibiotics versus a mean of 2.0 (SD, ±2.6) if not.

The odds of receiving antibiotics increased by a factor of 1.27 for every 50% increase in initial PCT level. Initial PCT level was highest for those with proven/probable bPNA and was associated with antibiotic initiation (odds ratio, 1.23; 95% confidence interval [CI], 1.17 to 1.30). Initial PCT (rate ratio [RR], 1.04; 95% CI, 1.01 to 1.08), change in PCT over time (RR, 1.03; 95% CI, 1.01 to 1.05), and bPNA group (RR, 1.51; 95% CI, 1.23 to 1.84) were associated with antibiotic duration.

“Although we identified an association between serum PCT trends and antibiotic initiation and duration, we were unable to determine whether PCT causally drove treatment decisions,” the study authors wrote. “Future prospective studies are needed to determine whether PCT data can be used to safely make decisions around antibiotic treatment for bacterial infection in COVID-19 patients, including when to start or stop antimicrobial therapy in patients with an elevated PCT level but no other signs or symptoms of bacterial coinfection.”
Nov 4 Infect Control Hosp Epidemiol study


Survey evaluates antibiotic attitudes, practices in Egypt

A survey of Egyptian physicians found high levels of knowledge about antibiotic use and resistance, and a good attitude toward appropriate antibiotic use, but assessment of clinical vignettes suggests that it may not translate into more appropriate prescribing, researchers reported yesterday in PLOS One.

The survey was given to 153 physicians dealing with acute upper respiratory tract infections (URTIs) in different healthcare settings in Egypt’s Assiut district from September 2021 through February 2022. The four-part survey asked respondents about sociodemographic and professional characteristics, education, factors influencing antibiotic prescribing, knowledge of antibiotic use and resistance, and attitudes toward appropriate prescribing. In the fourth part, respondents were asked to evaluate four different clinical vignettes, provide a diagnosis, and determine whether an antibiotic would be needed.

The mean age of respondents was 32.2 years, 57.5% were women, and 64.1% were pediatric residents. Nearly 89% reported that they rely on their clinical assessment for prescribing antibiotics in cases of URTIs, followed by reported symptoms by patients or their parents (60%).

Out of the 17 knowledge questions, the mean number of correct answers was 12.4. Mean attitude scores for inappropriate prescribing were low, which was consistent with respondents’ reports about the factors affecting their prescribing and cases of acute URTI’s in which the patients’ expectations were listed as the most negligible factor.

But of the 612 clinical vignettes evaluated, which involved two scenarios with viral URTIs and two with bacterial URTIs, antibiotics were prescribed in 326 (53.3%), and those prescriptions were appropriate in only 8.3% of cases. The percentage of inappropriate prescriptions was high because of the wrong choice of antibiotic, the wrong duration of antibiotic, and the use of injectable or combined antibiotics.

“More research is required to determine the causes of improper antibiotic prescribing and non-compliance with guidelines,” the study authors wrote. “Also, it is crucial to set up a national antibiotic stewardship program to improve antibiotic prescribing and contain antimicrobial resistance problems.”

The authors note that the study aims to help Egypt achieve the first and second goals of its National Action Plan for antimicrobial resistance (AMR), which focus on improving awareness of AMR and promoting rational antibiotic use.
Nov 3 PLOS One study