Impact of COVID-19 on Antibiotic Stewardship, Antimicrobial Resistance, and Prescribing Habits at Two General Hospitals in Abu Dhabi: A Retrospective Analysis

Introduction<br /> The COVID-19 pandemic has overwhelmingly affected healthcare systems, particularly in the area of antibiotic management. The surge in antimicrobial use to address secondary bacterial infections in COVID19 patients has heightened concerns about overuse and antimicrobial resistance (AMR). This study examined the pandemic's effect on the antibiotic stewardship program (ASP) at two general hospitals in Abu Dhabi, focusing on changes in prescribing practices, adherence to stewardship guidelines, resistance trends, and overall health system impact. The present retrospective study evaluated shifts in antibiotic consumption, compliance with stewardship practices, and broader healthcare implications. The aim is to assess the pandemic's impact, identify improvement areas, and provide insights to enhance the ASP in addressing the global AMR crisis.<br /> Methods<br /> This retrospective review assessed electronic medical records from two general hospitals in Abu Dhabi over a 24-month period, from January 2019 to December 2020. It included pre-COVID-19 data from 2019 and data from 2020 during the COVID-19 surge. The study focused on patients aged 25 to 40 years with respiratory tract infections, urinary tract infections, ventilator-associated pneumonia, and nosocomial infections, identified using predefined ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) codes. Patients with COVID-19 diagnoses and those undergoing surgical procedures were excluded. Key metrics compared data from 2019 and 2020 to assess changes in clinicians' prescribing practices, antibiotic usage, ASP interventions, and their impact on the healthcare system.<br /> Results<br /> The COVID-19 pandemic influenced antibiotic use and resistance trends, leading to longer hospital stays (3.86 days in 2019 vs. 4.29 days in 2020) and increased use of duplicate anaerobic therapy (4.58% in 2019 vs. 5.71% in 2020). From 2019 to 2020, the average duration of antibiotic therapy decreased from 6.23 days to 5.24 days, but empirical therapy without sufficient evidence rose. The average length of treatment increased (2.87 days in 2019 vs. 3.28 days in 2020), and there was a rise in the use of antibiotics for viral and fungal infections, with cases growing from 17.08% in 2019 to 22.38% in 2020. Despite modest improvements in stewardship practices in 2020, AMR challenges persisted. These results underscore the need for enhanced stewardship programs and continued research to address the ongoing impact on antibiotic prescribing and resistance. Conclusion The COVID-19 pandemic increased antibiotic use and altered resistance patterns. Although stewardship practices improved, AMR challenges remained. Enhanced stewardship programs and ongoing research are essential to mitigate these effects and improve antibiotic management.<br /> Recommendation<br /> To address changes in antibiotic use and resistance during the COVID-19 pandemic, it is recommended to strengthen ASPs to adapt to new prescribing trends, ensure adherence to evidence-based practices, provide ongoing education for clinicians, invest in research on long-term resistance impacts, and enhance data tracking and monitoring systems.