ArticleFrontiers in pharmacology2026
Effectiveness and safety of a prospective audit and feedback-based antimicrobial stewardship program in hospitalized COVID-19 patients: a quasi-experimental before-and-after study.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Antibiotic use among hospitalized patients with confirmed active SARS-CoV-2 infection is notably high (>70%) compared to the incidence of bacterial coinfections and superinfections (3.5% and 14.3%, respectively). Unjustified antimicrobial use poses preventable risks due to its toxicity and potential for long-term negative consequences. In this context, antimicrobial stewardship programs (ASPs) play a pivotal role in optimizing antibiotic therapy for COVID-19 patients. Methods: A quasi-experimental, before-and-after study was conducted to assess the impact of the COVID-ASP. The pre-ASP cohort included patients retrospectively, while the ASP cohort included patients prospectively, following the program implementation. The primary outcome was the evaluation of the impact of the COVID-ASP on days of therapy (DOT)/1,000 patient-days. Secondary outcomes included the rate of antibiotic use, rate of inappropriate use, number of recommendations made, their acceptance rate, the incidence of Results: A total of 1,289 patients admitted were included, 561 (43.5%) in the pre-ASP cohort and 728 (56.5%) in the ASP cohort. The COVID-ASP cohort showed a significantly lower DOT/ 1,000 patient-days (162.96 vs. 105.71; p < 0.001). Additionally, the COVID-ASP was associated with a significant reduction in the rate of antibiotic use for suspected pneumonic coinfections (13.2% vs. 5.9%, p < 0.001), for all causes (17.5% vs. 12.5%, p = 0.012), and for pneumonic superinfection (9.3% vs. 5.9%, p = 0.022). No significant difference was observed in antibiotic use for superinfection from all causes (16.0% vs. 16.2%, p = 0.936). The program also reduced the inappropriate antibiotic use rate for suspected pneumonic coinfection (8.7% vs. 1.9%, p < 0.001), for all causes (10.3% vs. 4.0%, p < 0.001), and for pneumonic superinfection (4.3% vs. 1.9%, p = 0.013). However, it showed no impact on inappropriate antibiotic use in superinfections across all causes (5.9% vs. 5.2%, p = 0.605). The most common recommendations included discontinuing antibiotics (58.6%) and adjusting the antibiotic regimen (30.3%). The program showed no significant effect on the incidence of Conclusion: In our experience, the three-step evaluation methodology allows for the evaluation of antibiotic prescriptions in patients with COVID-19 and allows for their optimization.
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