However, fewer than 80% correctly answered that using antibiotics increases a patient’s risk of antimicrobial resistant infection or that resistant bacteria can spread from person to person. HCWs correctly answered that antibiotics are not effective against viruses (97%), they have associated side effects (97%), unnecessary use makes antibiotics ineffective (97%) and healthy people can carry antibiotic-resistant bacteria (90%). The highest proportion were nursing and midwifery professionals (42%), pharmacists (23%) and medical doctors (18%). RESULTS: In total, 2404 participants responded. The UK target quota was 1315 respondents. METHODS: A 43-item questionnaire was developed through a two-round modified Delphi consensus process. Remote, one-sided provision of AMS strategies is unlikely to change prescribing initial clinician engagement and understanding needs to be monitored to avoid misunderstanding and suboptimal use.īACKGROUND: Using the COM-B model as a framework, an EU-wide survey aimed to ascertain multidisciplinary healthcare workers’ (HCWs’) knowledge, attitudes and behaviours towards antibiotics, antibiotic use and antibiotic resistance. POC-CRPTs was used more when allocated to one person.Ĭlinicians need detailed information on exactly how to adopt AMS strategies. Champions in five practices initiated changes to encourage use of at least one AMS strategy, mostly POC-CRPTs one practice chose all three. Engagement with intervention materials differed substantially between practices and depended on individual champions’ preconceptions of strategies and the opportunity to conduct implementation tasks. There was no evidence that the intervention affected prescribing. Surveys and interviews were conducted with professionals to capture experiences of using the intervention. Intervention use was assessed through monitoring. Routinely collected prescribing data were compared between the intervention and the control practices. This was primarily delivered remotely via a website with practices required to identify an ‘antibiotic champion’. Nine high-prescribing practices had access to the intervention for 12 months from November 2019. To investigate the use of the intervention in high-prescribing practices and its effect on antibiotic prescribing. The authors co-developed an implementation intervention to improve use of three AMS strategies: enhanced communication strategies, delayed prescriptions, and point-of-care C-reactive protein tests (POC-CRPTs). However, many are not commonly used in England. Trials have identified antimicrobial stewardship (AMS) strategies that effectively reduce antibiotic use in primary care. Furthermore, as the use of antibiotics during the study period appears to have been largely empirical, clinical guidelines to promote and support more targeted administration of antibiotics in patients admitted to hospital with COVID-19 are required. There is currently insufficient evidence to support widespread empirical use of antibiotics in most hospitalised patients with COVID-19, as the overall proportion of bacterial co-infection is low. Few studies described criteria for stopping antibiotics. Empirical antibiotic use rate was 62% (95% CI 55% to 69% 11 studies). Overall antibiotic use was 60% (95% CI 52% to 68% 52 studies). When only confirmed bacterial co-infections were included the prevalence was 4% (95% CI 3% to 6% 20 studies). The overall prevalence of bacterial co-infection was 11% (95% CI 8% to 16% 70 studies). We retrieved 6,798 studies and included 85 studies with data from more than 30,000 patients. Where available, data on duration and type of antibiotics, adverse events, and any information about antibiotic stewardship policies were also collected. We included studies that reported proportion/prevalence of bacterial co-infection in hospitalized COVID-19 patients and use of antibiotics. Systematic review and meta-analysis was performed using major databases up to May 5, 2021. To estimate the frequency of bacterial co-infection in COVID-19 hospitalized patients and of antibiotic prescribing during the early pandemic period and to appraise the use of antibiotic stewardship criteria. Understanding the proportion of patients with COVID-19 who have respiratory bacterial co-infections and the responsible pathogens is important for managing COVID-19 effectively while ensuring responsible antibiotic use.
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