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The Importance of Antimicrobial Stewardship in Patients Coinfected with COVID-19 and Sepsis

To reduce the risk of antimicrobial resistance, rapid laboratory diagnostics are needed to identify the pathogens in hospital patients with COVID-19 and sepsis.

The COVID-19 pandemic caused a global strain on healthcare resources, as well as an internal strain for many patients who contracted the virus. COVID-19 patients experience a wide and devastating range of symptoms, with some asymptomatic and others dying from their infection.

Critically ill COVID-19 patients may develop acute respiratory distress syndrome and septic shock. Patients hospitalized with severe COVID-19 are more likely to develop secondary infections, often initiated on antibiotics, that could lead to sepsis. These patients who present with sepsis, “a clinical condition of life-threatening organ dysfunction which is caused by an abnormal response to infection,” are at even greater risk of death.

One study, presented at the ongoing Making a Difference in Infectious Diseases (MAD-ID) 2022 Annual Meeting, stressed the need for rapid laboratory diagnostics to identify dangerous pathogens. Detecting and characterizing these pathogens will enable providers to limit unnecessary antibiotic use and begin targeted treatments.

Over-prescribing antibiotics drives antimicrobial resistance. Prescribing unnecessary antimicrobials can teach pathogens to mutate, enabling them to evade even the most potent therapies. Additionally, gratuitous antibiotics can kill off helpful bacteria, allowing the harmful bacteria to flourish in their absence.

Led by presenting author Temitayo Famoroti, MD, MPH, this descriptive study conducted a literature review to determine the prevalence of sepsis in hospitalized, critically ill COVID-19 patients. The investigators also looked for correlations between sepsis and antimicrobial therapy in this patient group.

They found that bloodstream infections are a significantly rising cause of morbidity and mortality in COVID-19 patients. Viral, bacterial, and fungal coinfections were higher in these patients, and death rates were as well. The investigators cited studies suggesting that over 70% of patient hospitalized with COVID-19 were given antibiotics, indicating over-prescription that could also be driving antimicrobial resistance.

Culture Independent Diagnostic Tests, such as the magnetic resonance (T2MR), metagenomic shotgun sequencing methods, and nucleic acid amplification platforms, have the potential to expedite pathogen detection. Thus, targeted therapies can be initiated instead of unnecessary antimicrobials.

The investigators concluded that more of these rapid laboratory diagnostic tests are needed to fight antimicrobial resistance, improve patient outcomes, and spare hospital resources.

This study, “The intersection of COVID-19 and Sepsis and the role of Anti-Microbial Stewardship in addressing Anti-Microbial Resistance,” was accepted as an abstract for the Making a Difference in Infectious Diseases (MAD-ID) 2022 Annual Meeting.