{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T10:56:54Z","timestamp":1774004214015,"version":"3.50.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antibiotic use among hospitalized patients with confirmed active SARS-CoV-2 infection is notably high (&amp;gt;70%) compared to the incidence of bacterial coinfections and superinfections (3.5% and 14.3%, respectively). Unjustified antimicrobial use poses preventable risks due to its toxicity and potential for long-term negative consequences. In this context, antimicrobial stewardship programs (ASPs) play a pivotal role in optimizing antibiotic therapy for COVID-19 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A quasi-experimental, before-and-after study was conducted to assess the impact of the COVID-ASP. The pre-ASP cohort included patients retrospectively, while the ASP cohort included patients prospectively, following the program implementation. The primary outcome was the evaluation of the impact of the COVID-ASP on days of therapy (DOT)\/1,000 patient-days. Secondary outcomes included the rate of antibiotic use, rate of inappropriate use, number of recommendations made, their acceptance rate, the incidence of\n                      <jats:italic>Clostridioides difficile<\/jats:italic>\n                      infection, 30-day mortality, and 30-day readmissions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1,289 patients admitted were included, 561 (43.5%) in the pre-ASP cohort and 728 (56.5%) in the ASP cohort. The COVID-ASP cohort showed a significantly lower DOT\/ 1,000 patient-days (162.96 vs. 105.71; p &amp;lt; 0.001). Additionally, the COVID-ASP was associated with a significant reduction in the rate of antibiotic use for suspected pneumonic coinfections (13.2% vs. 5.9%, p &amp;lt; 0.001), for all causes (17.5% vs. 12.5%, p = 0.012), and for pneumonic superinfection (9.3% vs. 5.9%, p = 0.022). No significant difference was observed in antibiotic use for superinfection from all causes (16.0% vs. 16.2%, p = 0.936). The program also reduced the inappropriate antibiotic use rate for suspected pneumonic coinfection (8.7% vs. 1.9%, p &amp;lt; 0.001), for all causes (10.3% vs. 4.0%, p &amp;lt; 0.001), and for pneumonic superinfection (4.3% vs. 1.9%, p = 0.013). However, it showed no impact on inappropriate antibiotic use in superinfections across all causes (5.9% vs. 5.2%, p = 0.605). The most common recommendations included discontinuing antibiotics (58.6%) and adjusting the antibiotic regimen (30.3%). The program showed no significant effect on the incidence of\n                      <jats:italic>Clostridioides difficile<\/jats:italic>\n                      infections (0% vs. 0.1%, p = 0.379), 30-day mortality (15.2% vs. 18.1%, p = 0.156), or 30-day readmission rates (4.8% vs. 4.9%, p = 0.469).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In our experience, the three-step evaluation methodology allows for the evaluation of antibiotic prescriptions in patients with COVID-19 and allows for their optimization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1662195","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T08:41:19Z","timestamp":1773996079000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness and safety of a prospective audit and feedback-based antimicrobial stewardship program in hospitalized COVID-19 patients: a quasi-experimental before-and-after study"],"prefix":"10.3389","volume":"17","author":[{"given":"Ariana","family":"Mart\u00ednez-Su\u00e1rez","sequence":"first","affiliation":[{"name":"Pharmacy Department, University Hospital Virgen Macarena","place":["Seville, Spain"]},{"name":"Pharmacy Department, University Hospital Son Espases","place":["Palma de Mallorca, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Salamanca-Rivera","sequence":"additional","affiliation":[{"name":"Unidad Cl\u00ednica de Enfermedades Infecciosas y Microbiolog\u00eda, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena, CSIC","place":["Seville, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red en Enfermedades Infecciosas (CIBERINFEC)","place":["Madrid, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaime","family":"Cordero-Ramos","sequence":"additional","affiliation":[{"name":"Pharmacy Department, University Hospital Virgen Macarena","place":["Seville, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jes\u00fas","family":"Rodr\u00edguez-Ba\u00f1o","sequence":"additional","affiliation":[{"name":"Unidad Cl\u00ednica de Enfermedades Infecciosas y Microbiolog\u00eda, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena, CSIC","place":["Seville, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red en Enfermedades Infecciosas (CIBERINFEC)","place":["Madrid, Spain"]},{"name":"Departamento de Medicina, Universidad de Sevilla","place":["Sevilla, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pilar","family":"Retamar-Gentil","sequence":"additional","affiliation":[{"name":"Unidad Cl\u00ednica de Enfermedades Infecciosas y Microbiolog\u00eda, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena, CSIC","place":["Seville, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red en Enfermedades Infecciosas (CIBERINFEC)","place":["Madrid, Spain"]},{"name":"Departamento de Medicina, Universidad de Sevilla","place":["Sevilla, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3359","DOI":"10.1097\/MS9.0000000000000761","article-title":"Assessing serum C-reactive protein as a predictor of COVID-19 outcomes: a retrospective cross-sectional study","volume":"85","author":"Abdullah","year":"2023","journal-title":"Ann. 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