DECEMBER - JANUARYLIFE SCIENCES REVIEW 19CXO INSIGHTSBy Sonia N. Rao, PharmD, BCIDP and Davide Manissero, MD, MRCPCH, MSc, DTM&H, QIAGEN COULD A SYNDROMIC DIAGNOSIS OVERCOME CHALLENGES FACED BY ANTIMICROBIAL STEWARDSHIP PROGRAMS DURING THE COVID-19 PANDEMIC?he Coronavirus Disease 2019 (COVID-19) pandemic has presented an unprecedented challenge to public health and has had a significant impact on healthcare resource utilization. A newfound concern presenting extreme challenges to Antimicrobial Stewardship Programs (ASP) is the high rates of prescribed antibiotics to patients with either confirmed or suspected COVID-19 which potentially further contributes to antimicrobial resistance (AMR). Even prior to the pandemic, there were 2.8 million antibiotic-resistant infections that accounted for 35,000 deaths from AMR and an excess of $20 billion in health-care expenditure within the United States alone1. TAs many patients with COVID-19 present with overlapping clinical and radiological findings of respiratory illness that are consistent with a range of respiratory pathogens, including bacteria, it is no surprise that healthcare providers begin empiric antimicrobial therapy per standard of care. However, limited and variable data exist on rates of bacterial infection associated with COVID-192,3. A systematic analysis by Langford et al. demonstrated that the overall proportion of COVID-19 cases with bacterial co-infection was 6.9% (95% CI; 4.3-9.5%), of which 3.5% were co-infections on presentation, 14.3% were secondary infections post-COVID-19, and higher rates of co-infection were seen in critically ill patients (8.1%, 95% CI; 2.3-13.8%)4. Interestingly, despite the relatively low rates of bacterial co-infections with COVID-19, 72% of patients were treated with antibiotics for undefined durations. Additionally, there is an interesting trend in antimicrobial prescription practices observed when comparing bacterial infection rates stratified by location of care. In the community setting, three studies described decreased antimicrobial use and reduced diagnosable infections following "lockdowns," and this trend persisted even as COVID-19 cases fell potentially due to the associated mitigation measures5,6,7. On the other hand, the high rates of reported hospital-Davide ManisseroSonia N. Rao
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