PhD Thesis - The Impact of the COVID-19 Pandemic on Antimicrobial Stewardship in Acute-Care Settings and the Pharmacist Role

Antimicrobial resistance (AMR) is a major global public health threat, responsible for approximately 1.2 million deaths annually and exacerbated during the COVID-19 pandemic. In the UK, bloodstream infections increased by 11.7% between 2018 and 2022, highlighting the ongoing burden of resistant infections. Antimicrobial stewardship (AMS) aims to optimise antibiotic use; however, the COVID-19 pandemic significantly disrupted stewardship activities and prescribing practices.

This doctoral research investigated antibiotic prescribing patterns and AMS implementation in an NHS Foundation Trust in England before the pandemic (2019) and during the pandemic (2020), alongside healthcare professionals’ perspectives on AMS during COVID-19. Using a post-positivist mixed-methods approach, the research comprised: (1) a systematic review of AMS implementation strategies in acute-care settings before and during COVID-19; (2) a retrospective cross-sectional study assessing inappropriate empirical antibiotic prescribing among hospitalised adults; and (3) a prospective cross-sectional survey exploring healthcare professionals’ knowledge, attitudes, and perceptions of antibiotic prescribing and AMS during the pandemic.

Findings demonstrated persistently high rates of inappropriate prescribing (50% pre-pandemic vs 49% during the pandemic) and significant changes in AMS interventions, particularly antibiotic continuation and de-escalation practices. Over 80% of healthcare professionals reported negative impacts of the pandemic on AMS activities, notably antibiotic review and education. The study concludes that COVID-19 had a detrimental effect on AMS delivery and underscores the need for sustainable, data-driven, and innovative stewardship approaches to strengthen preparedness for future health crises.