Implementation of a pharmacist-driven biomarker-based remotely delivered antimicrobial stewardship strategy during the COVID-19 pandemic

Background: The in-person postprescription review-based antimicrobial stewardship (AMS) program was disrupted in acute care settings due to the implementation of rigorous infection control measures in response to the COVID-19 pandemic. The study assessed the feasibility of a pharmacist and biomarker-driven remote AMS strategy in COVID-19 inpatients of a hospital providing tertiary-level care in southern India. Methodology: During baseline phase, patients on antibiotics >48 h were screened and antimicrobial consumption indices such as days of therapy per 1000 patient days (days on therapy [DOT]/1000PD) and length of therapy (LOT) were measured. In the intervention phase, at 48 h of antimicrobial use, procalcitonin test (PCT) was sent. Based on the PCT levels and patient's clinical condition, an electronic alert was sent to the treating team to continue/de-escalate or discontinue an antibiotic. Results: During the preintervention phase, which lasted from July to October 2020, a total of 481 patients were enrolled, whereas in the intervention phase, which ran from December 2020 to March 2021, only 90 patients were enrolled. The total DOT/1000 patient days were 9269 in the baseline and 2032 in the intervention (78% reduction). There was a significant decrease in the total length of stay (LOT) from 3779 during the preintervention phase to 657 during the intervention phase. The treating team accepted 91.1% of the recommendations provided during the intervention phase. Conclusion: A simple innovative strategy helped curb indiscriminate antibiotic use when access to patients was limited during the COVID-19 pandemic.