{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:37:31Z","timestamp":1789591051185,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,10,30]],"date-time":"2022-10-30T00:00:00Z","timestamp":1667088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>The demographics and outcomes of ICU patients admitted for a COVID-19 infection have been characterized in extensive reports, but little is known about antimicrobial stewardship for these patients. We designed this retrospective, observational study to investigate our hypothesis that the COVID-19 pandemic has disrupted antimicrobial stewardship practices and likely affected the rate of antibiotic de-escalation (ADE), patient outcomes, infection recurrence, and multidrug-resistant bacteria acquisition. We reviewed the prescription of antibiotics in three ICUs during the pandemic from March 2020 to December 2021. All COVID-19 patients with suspected or proven bacterial superinfections who received antibiotic treatment were included. The primary outcome was the rate of ADE, and secondary outcomes included the rate of appropriate empirical treatment, mortality rates and a comparison with a control group of infected patients before the COVID-19 pandemic. We included 170 COVID-19 patients who received antibiotic treatment for a suspected or proven superinfection, of whom 141 received an empirical treatment. For the latter, antibiotic treatment was de-escalated in 47 (33.3%) patients, escalated in 5 (3.5%) patients, and continued in 89 (63.1%) patients. The empirical antibiotic treatment was appropriate for 87.2% of cases. ICU, hospital, and day 28 and day 90 mortality rates were not associated with the antibiotic treatment strategy. The ADE rate was 52.2% in the control group and 27.6% in the COVID-19 group (p &lt; 0.001). Our data suggest that empirical antibiotic treatment was appropriate in most cases. The ADE rates were lower in the COVID-19 group than in the control group, suggesting that the stress associated with COVID-19 affected our practices.<\/jats:p>","DOI":"10.3390\/antibiotics11111517","type":"journal-article","created":{"date-parts":[[2022,10,30]],"date-time":"2022-10-30T09:01:42Z","timestamp":1667120502000},"page":"1517","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Antimicrobial Stewardship during COVID-19 Outbreak: A Retrospective Analysis of Antibiotic Prescriptions in the ICU across COVID-19 Waves"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0049-6248","authenticated-orcid":false,"given":"Ines","family":"Lakbar","sequence":"first","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Marseille, Department of Anesthesiology and Intensive Care, H\u00f4pital Nord, Aix-Marseille University, 13015 Marseille, France"},{"name":"CEReSS, Health Service Research and Quality of Life Centre, School of Medicine\u2014La Timone Medical, Aix-Marseille University, 13006 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4051-3834","authenticated-orcid":false,"given":"Louis","family":"Delamarre","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Marseille, Department of Anesthesiology and Intensive Care, H\u00f4pital Nord, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanny","family":"Curtel","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Marseille, Department of Anesthesiology and Intensive Care, H\u00f4pital Nord, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3305-0077","authenticated-orcid":false,"given":"Gary","family":"Duclos","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Marseille, Department of Anesthesiology and Intensive Care, H\u00f4pital Nord, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karine","family":"Bezulier","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Marseille, Department of Anesthesiology and Intensive Care, H\u00f4pital Nord, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Gragueb-Chatti","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Marseille, Department of Intensive Care Medicine, H\u00f4pital Nord, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5834-4063","authenticated-orcid":false,"given":"Ignacio","family":"Martin-Loeches","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care Medicine, St. James\u2019s Hospital, D08 NHY1 Dublin, Ireland"},{"name":"Multidisciplinary Intensive Care Research Organization (MICRO), St James\u2019s Hospital, D08 NHY1 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marie","family":"Forel","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Marseille, Department of Intensive Care Medicine, H\u00f4pital Nord, Aix-Marseille University, 13015 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3097-758X","authenticated-orcid":false,"given":"Marc","family":"Leone","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Marseille, Department of Anesthesiology and Intensive Care, H\u00f4pital Nord, Aix-Marseille University, 13015 Marseille, France"},{"name":"CEReSS, Health Service Research and Quality of Life Centre, School of Medicine\u2014La Timone Medical, Aix-Marseille University, 13006 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.ijid.2021.10.034","article-title":"Surging Bloodstream Infections and Antimicrobial Resistance during the First Wave of COVID-19: A Study in a Large Multihospital Institution in the Paris Region","volume":"114","author":"Amarsy","year":"2022","journal-title":"Int. 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