This statement addresses the inappropriate antibiotic prescribing occurring during the coronavirus 2019 pandemic (COVID-19) that has exacerbated another urgent public health crisis: antibiotic resistance in bacterial and fungal pathogens. 1 - 3 Ramifications of overprescribing have led to infections with multidrug-resistant organisms (MDROs) such as extended-spectrum β-lactamase–producing gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA).4 These infections complicate patient treatment, prolong hospital stays, and lead to worse outcomes.5
The emergence of severe acute respiratory virus coronavirus 2 (SARS-CoV-2), has resulted in an unprecedented pandemic with >535 million cases worldwide and >6 million deaths as of June 2022. 6 The United States has reported >85 million cases and >1 million deaths, 7 surpassing the number caused by the 1918 influenza pandemic.8 The pandemic has reinforced prior analyses, which identified numerous vulnerabilities, including inconsistent funding for US public health preparedness and response that contributed to inadequate resources for treatment, testing, and contact tracing, and breakdowns in the supply chain for essential healthcare equipment.9–11
As a new disease, COVID-19 led to rapidly evolving information, particularly early in the pandemic. Patients with COVID-19 can present with severe illness and clinical and laboratory findings suggestive of bacterial coinfection. Because bacterial coinfection seen with other viral respiratory infections—particularly influenza—may increase a patient’s morbidity and mortality,12 the same concern was present for COVID-19. Consequently, inappropriate antibiotic use has increased.4,13,14
In this paper, we discuss the conditions of the COVID-19 pandemic that resulted in inappropriate antibiotic use in adult hospitalized patients and approaches to improve practice for the next public health emergency, as well as the central role of antibiotic stewardship programs (ASPs) in pandemic response (Fig. 1). Table 1 provides an overview of the acronyms used in the manuscript. Table 2 summarizes the recommendations.
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