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Antibiotics Use in COVID-19 and Respiratory Tract Infections

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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (30 June 2024) | Viewed by 15233

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Special Issue Editors

Prof. Dr. Shailendra K. Saxena

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Guest Editor

1. Centre for Advanced Research, Faculty of Medicine, King George’s Medical University, Lucknow 226003, India
2. The World Society for Virology, Northampton, MA, USA
Interests: infectious diseases; emerging and reemerging pathogens; therapeutics and drug-development

Dr. Swatantra Kumar

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Assistant Guest Editor

1. Centre for Advanced Research, Faculty of Medicine, King George’s Medical University (KGMU), Lucknow, India
2. The World Society for Virology, Northampton, MA, USA
Interests: infectious diseases; immunology, vaccine development

Special Issue Information

Dear Colleagues,

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become an on-going global health emergency with over 94 million cases, and more than 2 million deaths globally. Primarily identified as atypical pneumonia, it has developed into a severe acute respiratory distress syndrome, with multi-organ dysfunction and associated fatality. A rising number of reports have underlined the risk of increasing antimicrobial resistance due to antibiotic overuse in COVID-19 patients. This Special Issue seeks manuscript submissions that further our understanding of antibiotics use and antimicrobial treatment in COVID-19 and respiratory tract infections.

We look forward to receiving your contributions.

Prof. Dr. Shailendra K. Saxena
Dr. Swatantra Kumar
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

COVID-19
antibiotics use
respiratory tract infections

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Published Papers (7 papers)

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Research

14 pages, 981 KiB

Open AccessArticle

Increasing Fluroquinolone Susceptibility and Genetic Diversity of ESBL-Producing E. coli from the Lower Respiratory Tract during the COVID-19 Pandemic

by Katja Hrovat, Katja Seme and Jerneja Ambrožič Avguštin

Antibiotics 2024, 13(9), 797; https://doi.org/10.3390/antibiotics13090797 - 23 Aug 2024

Viewed by 718

Abstract

Lower respiratory tract infections (LRTIs) are the fourth leading cause of death worldwide, among which Escherichia coli (E. coli) pneumonia is considered a rare phenomenon. Treatment options for LRTIs have become limited, especially for extended-spectrum β-lactamase-producing E. coli (ESBL-EC), which are usually resistant to other groups of antimicrobials as well. The aim of our study was to compare the phenotypic resistance profiles and genotypes of ESBL-EC isolates associated with LRTIs before (pre-COVID-19) and during (COVID-19) the COVID-19 pandemic. All isolates were screened for antimicrobial resistance genes (ARGs) and virulence-associated genes (VAGs) and assigned to phylogenetic groups, sequence types and clonal groups by PCR. During the pandemic, a significantly lower proportion of ciprofloxacin-, levofloxacin- and trimethoprim-sulfamethoxazole-resistant ESBL-EC isolates was retrieved from lower respiratory tract (LRT) samples. PCR-based genotypization revealed greater clonal diversity and a significantly lower proportion of isolates with bla_TEM, aac(6′)-Ib-cr and qacEΔ1 genes. In addition, a higher proportion of isolates with the integrase gene int1 and virulence genes sat and tsh was confirmed. The lower prevalence of fluoroquinolone resistance and greater genetic diversity of ESBL-EC isolated during the COVID-19 period may have been due to the introduction of new bacterial strains into the hospital environment, along with changes in clinical establishment guidelines and practices. Full article

(This article belongs to the Special Issue Antibiotics Use in COVID-19 and Respiratory Tract Infections)

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20 pages, 1875 KiB

Open AccessArticle

Decline in ESBL Production and Carbapenem Resistance in Urinary Tract Infections among Key Bacterial Species during the COVID-19 Pandemic

by Ibraheem Altamimi, Khalifa Binkhamis, Abdullah Alhumimidi, Ibrahim M. Alabdulkarim, Abdulrahman Almugren, Hadi Alhemsi, Abdulaziz Altamimi, Abeer Almazyed, Seham Elbih, Razan Alghunaim and Abdullah Altamimi

Antibiotics 2024, 13(3), 216; https://doi.org/10.3390/antibiotics13030216 - 26 Feb 2024

Cited by 2 | Viewed by 2259

Abstract

The COVID-19 pandemic has led to significant changes in healthcare practices, including increased antibiotic usage. This study aimed to investigate the impact of the pandemic on the prevalence of extended-spectrum β-lactamase (ESBL) production and carbapenem resistance among key bacterial species causing urinary tract infections (UTIs). Conducted at King Fahad Medical City in Riyadh from January 2018 to December 2022, the study analyzed urine samples from 9697 UTI patients. Patients were categorized into ‘pre-COVID-19’ and ‘during COVID-19’ groups. Bacterial isolates were identified, and antimicrobial susceptibility testing was performed following guidelines. ESBL production was detected using the Double-Disc Synergy Test. Escherichia coli and Klebsiella pneumoniae were the main pathogens. During the pandemic, ESBL production decreased in E. coli by 1.9% and in K. pneumoniae by 6.0%. Carbapenem resistance also declined, with E. coli displaying a 1.2% reduction and K. pneumoniae and Pseudomonas aeruginosa displaying 10.7% and 7.9% reductions, respectively. Notably, logistic regression analysis revealed that the odds of ESBL presence were 10% lower during the COVID-19 pandemic (OR 0.91; 95% CI 0.83–0.99; p = 0.040), and there was a significant reduction in the odds of carbapenem resistance (OR 0.43; 95% CI 0.37–0.51; p < 0.001). This study reveals a significant decrease in ESBL production and carbapenem resistance among UTI pathogens during the COVID-19 pandemic, hinting at the impact of modified antibiotic and healthcare approaches. It emphasizes the need for persistent antimicrobial resistance surveillance and policy adaptation to address resistance challenges, offering key directions for future public health actions. Full article

(This article belongs to the Special Issue Antibiotics Use in COVID-19 and Respiratory Tract Infections)

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13 pages, 879 KiB

Open AccessArticle

Performance and Impact on Antibiotic Prescriptions of a Multiplex PCR in a Real-Life Cohort of Critically Ill Patients with Suspected Ventilated Pneumonia: A Retrospective Monocentric Observational Study

by Emma Chambe, Perrine Bortolotti, Rémy Diesnis, Caroline Laurans, Rozenn Héquette-Ruz, Sophie Panaget, Patrick Herbecq, Anne Vachée and Agnès Meybeck

Antibiotics 2023, 12(12), 1646; https://doi.org/10.3390/antibiotics12121646 - 21 Nov 2023

Cited by 1 | Viewed by 1532

Abstract

Pulmonary multiplex polymerase chain reaction (m-PCR) allows rapid pathogen detection. We aimed to assess its impact on initial antibiotic prescriptions in ventilated patients with suspected pneumonia. Between November 2020 and March 2022,ventilated patients with suspected pneumonia hospitalized in our ICU who benefited from respiratory sampling simultaneously tested using conventional microbiological methods and m-PCR were included. The proportion of appropriate changes in the initial antibiotic therapy following m-PCR results was assessed. We analyzed 104 clinical samples. Of the 47 negative m-PCR results, 16 (34%) led to an appropriate antibiotic strategy: 8 cessationsand 8 lack of initiation. Of the 57 positive m-PCR results, 51 (89%) resulted in an appropriate antibiotic strategy: 33 initiations, 2 optimizations, and 9 de-escalations. In the multivariate analysis, a positive m-PCR was associated with an appropriate antibiotic change (OR: 96.60; IC95% [9.72; 960.20], p < 0.001). A higher SAPS II score was negatively associated with an appropriate antibiotic change (OR: 0.96; IC95% [0.931; 0.997], p = 0.034). In our cohort, a positive m-PCR allowed for early initiation or adjustment of antibiotic therapy in almost 90% of cases. A negative m-PCR spared antibiotic use in onethird of cases. The impact of m-PCR results was reduced in the most severe patients. Full article

(This article belongs to the Special Issue Antibiotics Use in COVID-19 and Respiratory Tract Infections)

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11 pages, 794 KiB

Open AccessArticle

Pharmacoepidemiological Analysis of Antibacterial Agents Used in a Provisional Hospital in Aktobe, Kazakhstan, in the Context of COVID-19: A Comparison with the Pre-Pandemic Period

by Aigerim A. Balapasheva, Gaziza A. Smagulova, Aigul Z. Mussina, Liliya E. Ziganshina and Zhansulu Zh. Nurgaliyeva

Antibiotics 2023, 12(11), 1596; https://doi.org/10.3390/antibiotics12111596 - 6 Nov 2023

Cited by 3 | Viewed by 1523

Abstract

In the context of the global spread of Coronavirus Disease 2019 (COVID-19), the issue of evaluating and optimizing the use of antibacterial drugs becomes especially relevant. The coronavirus pandemic has provided a unique opportunity to study the dynamics of the consumption of antibacterial agents and their impact on public health. The rational use of antibiotics is a key aspect of the fight against antimicrobial resistance, which makes this study particularly important. The aim of this study was to assess changes in the consumption of antibacterial drugs among patients hospitalized with COVID-19 during the peak of the 2020 pandemic and compare them with data from 2019 prior to the pandemic. This study collated data on antibacterial drug consumption in a regional hospital in Aktobe, which served a large population of patients during the pandemic. A pharmacoepidemiological study was conducted using the Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) methodology. The pharmacoepidemiological study using the international ATC/DDD methodology revealed a concerning pattern of irrational consumption of antibacterial drugs, including cephalosporins, azalides, second-generation fluoroquinolones, and systemic aminoglycosides in Aktobe. Among antibacterial drugs during the pandemic, the most significant increase in consumption was from the group of cephalosporins (19,043 DDD/100 bed-days). The share of their consumption was 35.4% of the total consumption of antibacterial drugs. Pharmacoepidemiological studies using the international methodology ATC/DDD showed an alarming picture of irrational consumption of antibacterial drugs of the group of cephalosporins, azalides, fluoroquinolones, and aminoglycosides in Aktobe, and, in this case, excessive use of the identified antibiotics raises concerns about the possibility of increasing the problem of resistance to microbes. Full article

(This article belongs to the Special Issue Antibiotics Use in COVID-19 and Respiratory Tract Infections)

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12 pages, 292 KiB

Open AccessEditor’s ChoiceArticle

The Impact of Viral and Bacterial Co-Infections and Home Antibiotic Treatment in SARS-CoV-2 Hospitalized Patients at the Policlinico Tor Vergata Hospital, Rome, Italy

by Andrea Di Lorenzo, Laura Campogiani, Marco Iannetta, Roberta Iannazzo, Alessandra Imeneo, Grazia Alessio, Veronica D’Aquila, Barbara Massa, Ilenia Fato, Lorenzo Vittorio Rindi, Vincenzo Malagnino, Elisabetta Teti, Massimo Andreoni and Loredana Sarmati

Antibiotics 2023, 12(9), 1348; https://doi.org/10.3390/antibiotics12091348 - 22 Aug 2023

Cited by 3 | Viewed by 1777

Abstract

Co-infections during COVID-19 may worsen patients’ outcomes. This study reports the results of a screening assessing the presence of co-infections among patients hospitalized for SARS-CoV-2 infection in the Infectious Diseases-Ward of the Policlinico Tor Vergata Hospital, Rome, Italy, from 1 January to 31 December 2021. Data on hepatitis B and C virus, urinary antigens for legionella pneumophila and streptococcus pneumoniae, pharyngeal swab for respiratory viruses, QuantiFERON^®-TB Gold Plus assay (QFT-P), blood cultures and pre-hospitalization antibiotic prescription were recorded. A total of 482 patients were included, 61% males, median age of 65 years (IQR 52–77), median Charlson comorbidity index of 4 (IQR 2–5). The mortality rate was 12.4%; 366 patients needed oxygen supply. In total, 151 patients (31.3%) received home antibiotics without any association with the outcome. No significant association between mortality and the positivity of viral hepatitis markers was found. Out of 442 patients, 125 had an indeterminate QFT-P, associated with increased mortality. SARS-CoV-2 was the only respiratory virus detected among 389 pharyngeal swabs; 15/428 patients were positive for S. pneumoniae; none for L. pneumophila. In total, 237 blood cultures were drawn within 48 h from hospital admission: 28 were positive and associated with increased mortality. In our cohort, bacterial and viral co-infections in COVID-19 hospitalized patients were rare and not associated with higher mortality. Full article

(This article belongs to the Special Issue Antibiotics Use in COVID-19 and Respiratory Tract Infections)

14 pages, 1271 KiB

Open AccessArticle

Antibiotic Utilization during COVID-19: Are We Over-Prescribing?

by Nataša Bednarčuk, Ana Golić Jelić, Svjetlana Stoisavljević Šatara, Nataša Stojaković, Vanda Marković Peković, Miloš P. Stojiljković, Nina Popović and Ranko Škrbić

Antibiotics 2023, 12(2), 308; https://doi.org/10.3390/antibiotics12020308 - 2 Feb 2023

Cited by 22 | Viewed by 3281

Abstract

The aims of this study were to analyze the utilization of antibiotics before (2018, 2019) and during the COVID-19 pandemic (2020) and the practice of prescribing antibiotics in outpatient settings for COVID-19 patients during the 2020–2022 period. The Anatomical Therapeutic Chemical Classification/Defined Daily Dose methodology was used for the analysis of outpatient antibiotic utilization in the Republic of Srpska. The data was expressed in DDD/1000 inhabitants/day. The rate of antibiotics prescribed to COVID-19 outpatients was analyzed using medical record data from 16,565 patients registered with B34.2, U07.1, and U07.2 World Health Organization International Classification of Diseases 10th revision codes. During 2020, outpatient antibiotic utilization increased by 53.80% compared to 2019. At least one antibiotic was prescribed for 91.04%, 83.05%, and 73.52% of COVID-19 outpatients during 2020, 2021, and the first half of 2022, respectively. On a monthly basis, at least one antibiotic was prescribed for more than 55% of COVID-19 outpatients. The three most commonly prescribed antibiotics were azithromycin, amoxicillin/clavulanic acid, and doxycycline. The trend of repurposing antibiotics for COVID-19 and other diseases treatment might be a double-edged sword. The long-term effect of this practice might be an increase in antimicrobial resistance and a loss of antibiotic effectiveness. Full article

(This article belongs to the Special Issue Antibiotics Use in COVID-19 and Respiratory Tract Infections)

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9 pages, 837 KiB

Open AccessArticle

Implementation of MRSA Nasal Swabs as an Antimicrobial Stewardship Intervention to Decrease Anti-MRSA Therapy in COVID-19 Infection

by Alaina DeKerlegand, Emily Johnston, Britney Mellor, Melanie Rae Schrack and Catherine O’Neal

Antibiotics 2023, 12(2), 253; https://doi.org/10.3390/antibiotics12020253 - 27 Jan 2023

Viewed by 3270

Abstract

In the early stages of treating patients with SARS-CoV-2, limited information was available to guide antimicrobial stewardship interventions. The COVID-19 Task Force and Antimicrobial Stewardship Committee, at a 988-bed academic medical center, implemented the use of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab polymerase chain reaction (PCR) testing to assist with the de-escalation of anti-MRSA therapy in patients with suspected superimposed bacterial pneumonia in COVID-19. A retrospective study was conducted to evaluate the impact of MRSA nasal swab PCR testing on the rate of anti-MRSA therapy between 13 April 2020 and 26 July 2020. A total of 122 patients were included in the analysis. Of the patients included in the final analysis, 58 (47.5%) had anti-MRSA therapy discontinued and 41 (33.6%) avoided anti-MRSA therapy completely due to a negative swab result. With the implementation of MRSA nasal swab PCR testing in COVID-19 patients, anti-MRSA therapy was reduced in 81% of patients in this study. In patients who continued with anti-MRSA therapy, nasal swabs were either positive for MRSA or an alternative indication for anti-MRSA therapy was noted. Only three patients in the cohort had MRSA identified in a sputum culture, all of whom had anti-MRSA therapy continued. MRSA nasal swab PCR testing may serve as an effective antimicrobial stewardship tool in COVID-19 pneumonia. Full article

(This article belongs to the Special Issue Antibiotics Use in COVID-19 and Respiratory Tract Infections)

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