Abstract
Background: A novel viral disease known as the COVID-19 pandemic triggered substantial interruption to global healthcare, leading to increased antimicrobial consumption and disrupted antimicrobial stewardship, resulting in concerns regarding antimicrobial resistance (AMR) globally. Introducing various guidelines and therapeutic regimes (corticosteroids, monoclonal antibody and antivirals) to combat COVID-19 may decrease antimicrobial consumption. This thesis aimed to investigate the impact of the COVID-19 pandemic on antimicrobial stewardship (AMS), antimicrobial consumption (AMC), and AMR.Methods: Three phases were conducted. Initial systematic review and meta-analysis were performed to assess AMC in patients with COVID-19. A qualitative study was conducted to explore views and experiences. In-depth interviews were conducted with AMS teams in UK hospitals to report the impact of the COVID-19 pandemic on AMS. Lastly, Intervention time series analysis (ITSA) was employed at a regional NHS Trust in England to analyse changes in AMC and the consumption of COVID-19 therapeutic drugs, and to assess the resistance trends of gram-negative bacteria.
Results: The review identified high consumption of azithromycin, doxycycline, co-amoxiclav, and carbapenems during the pandemic. The meta-analysis revealed that 68% of COVID-19 patients received antimicrobial therapy, with varying usage between high-income (58%) and lower-middle-income (89%) countries. However, qualitative study AMS teams reported that AMS activities were severely hampered and were not the priority. Due to resource limitations and reallocation of staff to COVID-19 tasks. Irrational antibiotic prescribing occurred due to the absence of guidelines in the initial pandemic phase. AMS activities gradually resumed as healthcare services adapted to online or virtual working. Additionally, the analysis revealed an increase in AMC in wave one, which declined subsequently during the study period. Significant increases in the consumption of piperacillin/tazobactam (
Conclusion: The pandemic significantly disrupted AMS activities and led to increased AMC, particularly broadspectrum antibiotics, resulting in altered resistance patterns in gram-negative bacteria. The findings underscore the importance of sustaining AMS efforts, even during global health crises, to prevent the escalation of AMR.
| Date of Award | 16 Sep 2024 |
|---|---|
| Original language | English |
| Supervisor | Mamoon Al Deyab (Main Supervisor) & Barbara Conway (Co-Supervisor) |