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Experts lay out antibiotic stewardship lessons from COVID-19

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A panel of experts with the Society for Healthcare Epidemiology of America (SHEA) published a statement last week on ways to improve antibiotic use and stewardship during infectious disease pandemics and outbreaks.The statement, published in Infection Control & Hospital Epidemiology, addresses widespread inappropriate antibiotic use during the COVID-19 pandemic.

The height of unnecessary antibiotic use took place in the early stages of the pandemic, when hospitals were flooded with severely ill patients, diagnostic tests were unavailable or took several days to return results, no treatments were available, and healthcare providers wanted to do something to help.The situation has improved since then, with more reliable tests, quicker turnaround times, and established treatments reducing use of antibiotics in COVID-19 patients.

In cases in which empiric antibiotics are prescribed because of concerns about bacterial coinfections, they are discontinued quickly.Antibiotic initiation, however, has remained high, and there are concerns that antibiotic overprescribing in COVID-19 patients is one of the factors contributing to an increase in multidrug-resistant hospital infections.But the statement is less a criticism of how antibiotics have been misused during the pandemic than an acknowledgement of the challenges posed by COVID-19 and providers' difficulty not using antibiotics in an environment of heightened illness and uncertainty.

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