Background: COVID-19 and antimicrobial resistance (AMR) are two intersecting public health crises. Antimicrobial overuse in patients with COVID-19 threatens to contribute to the growing threat of AMR. Guidelines are fundamental in encouraging antimicrobial stewardship. We sought to assess the quality of antibiotic prescribing guidelines and recommendations in the context of COVID-19, and if these guidelines incorporate principles of antimicrobial stewardship.
Methods: We performed a systematic survey which included a search using the concepts “antibiotic/antimicrobial” in September to November 2022 of the eCOVID-19 living map of recommendations (RecMap) which aggregates and summarizes guidelines across a range of international sources and all languages. Guidelines providing explicit recommendations regarding antibacterial use in COVID-19 from any jurisdiction were eligible for inclusion. Guideline and recommendation quality were assessed using the AGREE II and AGREE-REX instruments, respectively. We extracted guideline characteristics including panel representation and the presence or absence of explicit statements related to antimicrobial stewardship (i.e., judicious antibiotic use, antimicrobial resistance or adverse effects as a consequence of antibiotic use). We used logistic regression to evaluate the relationship between guideline characteristics including quality and incorporation of antimicrobial stewardship principles.
Results: Twenty-eight guidelines with 63 antibiotic prescribing recommendations were included. Recommendations focused on antibiotic initiation (n=52, 83%) and less commonly antibiotic selection (n=13, 21%), and duration of therapy (n=15, 24%). Guideline and recommendation quality varied widely. Twenty (71%) guidelines incorporated at least one concept relating to antimicrobial stewardship. Including infectious diseases expertise on the guideline panel (OR 9.44, 97.5%CI: 1.09 to 81.59) and AGREE-REX score (OR 3.26, 97.5%CI: 1.14 to 9.31 per 10% increase in overall score) were associated with a higher odds of guidelines addressing antimicrobial stewardship.
Conclusion: There is an opportunity to improve antibiotic prescribing guidelines in terms of both quality and incorporation of antimicrobial stewardship principles. These findings can help guideline developers better address antibiotic stewardship in future recommendations beyond COVID-19. / Thesis / Master of Public Health (MPH) / COVID-19 and antimicrobial resistance (AMR) are two serious threats to public health. Inappropriate use of antibiotics in patients with COVID-19 can worsen AMR and make future infections harder to treat. Practice guidelines can help healthcare providers prescribe antibiotics wisely. Using antibiotics carefully to reduce their harms is called antibiotic stewardship. This study evaluated the quality of practice guidelines for antibiotic prescribing in patients with COVID-19. It also assessed if the guidelines included principles of antibiotic stewardship. We searched for guidelines in a database called the eCOVID-19 living map of recommendations (RecMap). We found 28 guidelines with 63 recommendations. Identified guidelines differed widely in quality. Just over two-thirds of guidelines addressed antibiotic stewardship. Guidelines developed along with infectious disease experts and guidelines with higher recommendation quality scores were more likely to address antibiotic stewardship. Our findings can help guideline developers better address antibiotic stewardship in future recommendations.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/29526 |
| Date | January 2023 |
| Creators | Langford, Bradley |
| Contributors | Schunemann, Holger |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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