Implementation of a Clinical Pharmacology-Centric Antimicrobial Stewardship Initiative within COVID-19 Intensive Care Units at a Leading Tertiary Care Referral Center in India

Background: The importance of antimicrobial stewardship during the COVID-19 pandemic remains underreported. Methods: We prospectively audited antimicrobial use in COVID-19 ICUs of a tertiary care center from April 2021 to June 2021 during the delta wave of COVID-19 in India. Prospective audits and feedback (PAF) were conducted concurrently during case discussions on all days during this period. A summary of feedback, including empiric antibiotic rationality, de-escalation, etc., was mailed to all the treating physicians every day. Results: 161 out of 183 patients (87.97%) were empirically prescribed antibiotics in COVID ICUs, with an average of three antibiotics per patient. The most commonly prescribed empiric antibiotic was piperacillin-tazobactam, followed by ceftriaxone and colistin. De-escalation was suggested in 45.2% of prescriptions, which were followed in 36.5% but delayed in around 16% of suggestions. The presence of multiple comorbidities with intubation and/or shock was the most common reason for initiating and continuing empirical antibiotics. Around 29.8% of the patients on antibiotics developed MDR infections, and Acinetobacter baumannii was the most common organism isolated, with an average length of stay of 20 (19.6 days). Conclusion: Antimicrobial stewardship can play an essential role in minimizing the use of unnecessary antimicrobials in COVID-19 patients.