Estimates show that nearly 70 percent of patients admitted to the hospital with suspected COVID-19 were given antibiotics. However, it was clear early in the pandemic that antibiotics were not very effective against the novel virus.
Still, they were prescribed—especially in intensive care units (ICU)—where a new study says the drugs are perceived as “magic bullets,” fueling an “antibiotic culture.” For example, up to 70 percent of ICU patients receive antibiotic therapy on any given day, but 30 to 60 percent of those prescriptions are unnecessary.
Based on their research, published in Social Science & Medicine, the scientists say antibiotic prescribing is shaped by urgency, hierarchy and uncertainty.
“By studying the culture of antibiotic prescribing in ICUs, we can see more clearly both the vulnerability of the looming antimicrobial resistance crisis and by contrast the perceived insignificance of stewarding antibiotic use when considered alongside the fragility of life amidst acute medical concerns regularly experienced in the unit,” said Katharina Rynkiewich, senior author and assistant professor at Florida Atlantic University.
Rynkiewich and co-authors conducted the study in 2018, prior to the COVID-19 pandemic, at both a public and private hospital in Florida. Study participants, who were all specialists in pulmonary and critical care across a range of rank and seniority, consistently expressed urgency and timeliness as the main rationale behind antibiotic prescribing. This was especially true in “complicated” cases, which the ICU is more likely to have than other hospital sections.
Existing ICU workflows, patient load and collaborating effectively with other teams in the unit were also cited as motivating factors in the administration of antibiotics. Researchers say it was clear from the respondent interviews that once an antibiotic had been decided upon as treatment, there was an urgency to have it administered to the patient. This concern was not just reflecting a desire for the ICU to be efficient, but a frustration about the lost time that could negatively impact a patient's recovery.
With urgency and timeliness prioritized, the researchers say mindful discussion of antibiotic selection, dosing, duration and the various other considerations that come into play with antimicrobial stewardship was not always present. The setting and dynamics of the ICU, they say, create a “uniquely strained culture of antibiotic prescribing.”
“Ultimately, the lack of sustained, mindful discussion surrounding antibiotic selection contributed to uncertainty about antibiotic use during critical moments of urgency in the unit,” reads the study.
Rynkiewich is continuing her research on the social and cultural dynamics of U.S. antibiotic prescribing practices, especially as antibiotic resistance continues to grow.
“For us, detailing how antibiotic prescription is a complex and dynamic social process in acute care hospital spaces adds value by unveiling the otherwise unwieldy black box of ‘culture’,” the anthropologist of health and medicine said.
There are additional global challenges beyond the emergence of superbugs, including the possibility of another deadly pandemic.
“The future of antibiotic-resistant pathogens is driven, in part, by how society decides to utilize antibiotics,” said Rynkiewich. “These decisions are influenced by changing environmental conditions such as was experienced during the COVID-19 pandemic.”