Существует ли необходимость в широком назначении антибиотиков пациентам с COVID-19?

Последние два года пандемия SARS-CoV-2 доминировала во всех аспектах здравоохранения во всем мире, оставляя нередко другие долгосрочные  общественные  проблемы  со здоровьем в тени. Несмотря  на то, что COVID-19 является вирусным  заболеванием, применение  антибиотиков (АБ) у этих пациентов было обычной практикой, особенно в начале пандемии. Использование АБ у больных новой короновирусной  инфекцией (НКИ) достигает более 70% случаев. Подозрение на сопутствующую бактериальную инфекцию, отсутствие эффективных средств лечения НКИ, терминологические проблемы, связанные  с определением «пневмония», возможно, были мотивирующим фактором  такого широкого  использования. Данные  проведённых  исследований  свидетельствуют, что в настоящее время недостаточно доказательств для широкого эмпирического использования антибиотиков у большинства госпитализированных больных, так как общая доля бактериальных инфекций при COVID-19 достаточно низкая. Так, по данным большинства исследователей, сочетанная  бактериальная  инфекция встречается редко и составляет  менее 10%. Необоснованное назначение  антибиотиков  пациентам  с COVID-19 может привести к осложнениям, которых можно избежать, включая повышенную бактериальную резистентность, инфекцию Clostridioides  difficile, почечную  недостаточность  и многое другое. В статье представлена информация о частоте АБ терапии на различных этапах оказания медицинской помощи. Проведён анализ данных о характере антибиотиков,  назначаемых  у госпитализированных и амбулаторных пациентов с COVID-19 в разных странах. Представлены рекомендации разных стран по АБ терапии у больных COVID-19. Заключение. Рассмотренные данные подтверждают несоответствие между необоснованным и чрезмерным назначением антибиотиков пациентам с COVID-19 и малочисленностью доказательств ассоциированных бактериальных инфекций.

1. Karami Z., Knoop B.T., Dofferhoff A.S.M., Blaauw M.J.T., Janssen N.A., van Apeldoorn M. et al. Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: results from a multicentre retrospective cohort study in The Netherlands. Infect Dis ((Lond). 2021; 53: 2: 102–110. doi: 10.1080/23744235.2020.1839672.

2. Vaughn V.M., Gandhi T.N., Petty L.A., Patel P.K., Prescott H.C., Malani A.N. et al. Empiric antibacterial therapy and community-onset bacterial coinfection in patients hospitalized with coronavirus disease 2019 (COVID-19): a multi-hospital cohort study. Clin Infect Dis. 2021; 72 (10): e533–e541. doi: 10.1093/cid/ciaa1239.

3. Kubin C.J., McConville T.H., Dietz D., Zucker J., May M., Nelson B. et al. Characterization of Bacterial and Fungal Infections in Hospitalized Patients With Coronavirus Disease 2019 and Factors Associated With Health Care-Associated Infections. Open Forum Infect Dis. 2021 May 5; 8 (6): ofab201. doi: 10.1093/ofid/ofab201.

4. Karaba S.M., Jones G., Helsel T., Smith L.L., Avery R., Dzintars K. et al. Prevalence of co-infection at the time of hospital admission in COVID-19 patients, a multicenter study. Open Forum Infect Dis. 2020 Dec 21; 8 (1): ofaa578. doi: 10.1093/ofid/ofaa578.

5. Klein E.Y., Monteforte B., Gupta A., Jiang W., May L., Hsieh Y.H. et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respir Viruses. 2016 Sep; 10 (5): 394–403. doi: 10.1111/irv.12398.

6. Palacios G., Hornig M., Cisterna D., Savji N., Bussetti A.V., Kapoor V. et al. Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza. PLoS One. 2009 Dec 31; 4 (12): e8540. doi: 10.1371/journal.pone.0008540.

7. Синопальников А.И. Пандемия COVID-19 — «пандемия» антибактериальной терапии. Клиническая микробиология и антимикробная химиотерапия. 2021; 23 (1): 5–15. doi: 10.36488/cmac.2021.1.5-15.

8. Rusic D.,Vilovic M.,Bukic J.,Leskur D.,Seselja Perisin A.,Kumric M.et al. Implications of COVID-19 pandemic on the emergence of antimicrobial resistance: adjusting the response to future outbreaks. Life (Basel). 2021 Mar 10; 11 (3): 220. doi: 10.3390/life11030220.

9. Al-Hadidi S.H., Alhussain H., Abdel Hadi H., Johar A., Yassine H.M., Al Thani A.A. et al. The spectrum of antibiotic prescribing during COVID-19 pandemic: a systematic literature review. Microb Drug Resist. 2021 Dec; 27 (12): 1705–1725. doi: 10.1089/mdr.2020.0619.

10. Baskaran V., Lawrence H., Lansbury L.E., Webb K., Safavi S., Zainuddin N.I. et al. Co-infection in critically ill patients with COVID-19: an observational cohort study from England. J Med Microbiol. 2021 Apr; 70 (4): 001350. doi: 10.1099/jmm.0.001350.

11. Bendala Estrada A.D., Calderón Parra J., Fernández Carracedo E., Muiño Míguez A., Ramos Martínez A., Muñez Rubio E. et al. Inadequate use of antibiotics in the COVID-19 era: effectiveness of antibiotic therapy. BMC Infect Dis. 2021 Nov 8; 21 (1): 1144. doi: 10.1186/s12879-021-06821-1.

12. Buehler P.K., Zinkernagel A.S., Hofmaenner D.A., Wendel Garcia P.D., Acevedo C.T., Gómez-Mejia A. et al. Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients. Cell Rep Med. 2021 Apr 20; 2 (4): 100229. doi: 10.1016/j.xcrm.2021.100229.

13. Chedid M., Waked R., Haddad E., Chetata N., Saliba G., Choucair J. Antibiotics in treatment of COVID-19 complications: a review of frequency, indications, and efficacy. J Infect Public Health. 2021 May; 14 (5): 570–576. doi: 10.1016/j.jiph.2021.02.001.

14. Coenen S., de la Court J.R., Buis D.T.P., Meijboom L.J., Schade R.P., Visser C.E. et al. Low frequency of community-acquired bacterial co-infection in patients hospitalized for COVID-19 based on clinical, radiological and microbiological criteria: a retrospective cohort study. Antimicrob Resist Infect Control. 2021 Oct 30; 10 (1): 155. doi: 10.1186/s13756-021-01024-4.

15. Langford B.J., So M., Raybardhan S., Leung V., Soucy J.R., Westwood D. et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect. 2021 Apr; 27 (4): 520–531. doi: 10.1016/j.cmi.2020.12.018.

16. Lansbury L., Lim B., Baskaran V., Lim W.S. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020; 81 (2): 266–275. doi: 10.1016/j.jinf.2020.05.046.

17. Martin A.J., Shulder S., Dobrzynski D., Quartuccio K., Pillinger K.E. Antibiotic use and associated risk factors for antibiotic prescribing in COVID-19 hospitalized patients. J Pharm Pract. July 2021. doi: 10.1177/08971900211030248.

18. Moretto F., Sixt T., Devilliers H., Abdallahoui M., Eberl I., Rogier T. et al. Is there a need to widely prescribe antibiotics in patients hospitalized with COVID-19? Int J Infect Dis. 2021 Apr; 105: 256–260. doi: 10.1016/j.ijid.2021.01.051.

19. Neto A.G.M., Lo K.B., Wattoo A., Salacup G., Pelayo J., DeJoy R. 3rd et al. Bacterial infections and patterns of antibiotic use in patients with COVID-19. J Med Virol. 2021 Mar; 93 (3): 1489–1495. doi: 10.1002/jmv.26441.

20. Rawson T.M., Moore L.S.P., Zhu N., Ranganathan N., Skolimowska K., Gilchrist M. et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020 Dec 3; 71 (9): 2459–2468. doi: 10.1093/cid/ciaa530.

21. Rodríguez-Baño J., Rossolini G.M., Schultsz C., Tacconelli E., Murthy S., Ohmagari N. et al. Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance. Trans R Soc Trop Med Hyg. 2021 Oct 1; 115 (10): 1122–1129. doi: 10.1093/trstmh/trab048.

22. Russell C.D., Fairfield C.J., Drake T.M., Turtle L., Seaton R.A., Wootton D.G. et al. Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study. Lancet Microbe. 2021 Aug; 2 (8): e354–e365. doi: 10.1016/S2666-5247(21)00090-2.

23. Suranadi I.W., Sucandra I.M.A.K., Fatmawati N.N.D., Wisnawa A.D.F. A retrospective analysis of the bacterial infections, antibiotic use, and mortality predictors of COVID-19 patients. Int J Gen Med. 2022 Apr 1; 15: 3591–3603. doi: 10.2147/IJGM.S351180.

24. Ul Mustafa Z., Salman M., Aldeyab M., Kow C.S., Hasan S.S. Antimicrobial consumption among hospitalized patients with COVID-19 in Pakistan. SN Compr Clin Med. 2021; 3 (8): 1691–1695. doi: 10.1007/s42399-021-00966-5.

25. Wang L., Amin A.K., Khanna P., Aali A., McGregor A., Bassett P. et al. An observational cohort study of bacterial co-infection and implications for empirical antibiotic therapy in patients presenting with COVID-19 to hospitals in North West London. J Antimicrob Chemother. 2021 Feb 11; 76 (3): 796–803. doi: 10.1093/jac/dkaa475.

26. Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28; 395 (10229): 1054–1062. doi: 10.1016/S0140-6736(20)30566-3.

27. Shin D.H., Kang M., Song K.H., Jung J., Kim E.S., Kim H.B. A call for antimicrobial stewardship in patients with COVID-19: a nationwide cohort study in Korea. Clin Microbiol Infect. 2021 Apr; 27 (4): 653–655. doi: 10.1016/j.cmi.2020.10.024.

28. d'Humières C., Patrier J., Lortat-Jacob B., Tran-Dinh A., Chemali L., Maataoui N. et al. Two original observations concerning bacterial infections in COVID-19 patients hospitalized in intensive care units during the first wave of the epidemic in France. PLoS One. 2021 Apr 29; 16 (4): e0250728. doi: 10.1371/journal.pone.0250728.

29. Stevens R.W., Jensen K., O'Horo J.C., Shah A. Antimicrobial prescribing practices at a tertiary-care center in patients diagnosed with COVID-19 across the continuum of care. Infect Control Hosp Epidemiol. 2021 Jan; 42 (1): 89–92. doi: 10.1017/ice.2020.370.

30. Mustafa L., Tolaj I., Baftiu N., Fejza H. Use of antibiotics in COVID-19 ICU patients. J Infect Dev Ctries. 2021 Apr 30; 15 (4): 501–505. doi: 10.3855/jidc.14404.

31. Кароли Н.А., Апаркина А.В., Григорьева Е.В., Магдеева Н.А., Никитина Н.М., Ребров А.П. COVID-19 и антибактериальная терапия на стационарном этапе: кому, когда, зачем? Пульмонология. 2021; 31 (6): 701–709. doi: 10.18093/0869-0189-2021-31-6-701-709.

32. Cong, W., Poudel A.N., Alhusein N, Wang H., Yao G., Lambert H. Antimicrobial use in COVID-19 patients in the first phase of the SARS-CoV-2 pandemic: a scoping review. Antibiotics. 2021; 10: 745. doi: 10.3390/antibiotics10060745.

33. Mah-E-Muneer S., Hassan M.Z., Biswas M.A.A.J., Rahman F., Akhtar Z., Das P. et al. Use of antimicrobials among suspected COVID-19 patients at selected hospitals, Bangladesh: findings from the first wave of COVID-19 pandemic. Antibiotics (Basel). 2021 Jun 18; 10 (6): 738. doi: 10.3390/antibiotics10060738.

34. Rose A.N., Baggs J., Wolford H., Neuhauser M.M., Srinivasan A., Gundlapalli A.V. et al. Trends in antibiotic use in united states hospitals during the coronavirus disease 2019 pandemic. Open Forum Infect Dis. 2021 Jun 3; 8 (6): ofab236. doi: 10.1093/ofid/ofab23.

35. Van Laethem J.,Wuyts S.,Van Laere S.,Koulalis J.,Colman M.,Moretti M. et al. Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers. Intern Emerg Med. 2022; 17 (1): 141–145. doi: 10.1007/s11739-021-02790-0.

36. Seaton R.A., Gibbons C.L., Cooper L., Malcolm W., McKinney R., Dundas S. et al. Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals. J Infect. 2020; 81 (6): 952–960. doi: 10.1016/j.jinf.2020.09.024.

37. Townsend L., Hughes G., Kerr C., Kelly M., O'Connor R., Sweeney E. et al. Bacterial pneumonia coinfection and antimicrobial therapy duration in SARS-CoV-2 (COVID-19) infection. JAC Antimicrob Resist. 2020 Sep; 2 (3): dlaa071. doi: 10.1093/jacamr/dlaa071.

38. Stevenson D.R., Sahemey M., Cevallos Morales J., Martín-Lázaro J., Buchanan R., Serafino Wani R. Improving antimicrobial stewardship in critically-ill patients with COVID-19. Clin Infect Dis. 2021 Jun 1; 72 (11): e926. doi: 10.1093/cid/ciaa1559.

39. Lingscheid T.,Lippert L.J., Hillus D.,Kruis T., Thibeault C., Helbig E.T. et al. Characterization of antimicrobial use and co-infections among hospitalized patients with COVID-19: a prospective observational cohort study. Infection. 2022; 50 (6): 1441–1452. doi: 10.1007/s15010-022-01796-w.

40. Calderón-Parra J.,Muiño-Miguez A., Bendala-Estrada A.D., Ramos-Martínez A., Muñez-Rubio E.,Fernández Carracedo E. et al. Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analsis of the registry SEMI-COVID. PLoS One. 2021 May 11; 16 (5): e0251340. doi: 10.1371/journal.pone.0251340.

41. Could efforts to fight the coronavirus lead to overuse of antibiotics? [Internet]. The pew charitable trusts. 03/2021. Available from: https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/could-efforts-to-fight-the-coronavirus-lead-to-overuse-of-antibiotics

42. Dolk F.C.K.,Pouwels K.B.,Smith D.R.M.,Robotham J.V.,Smieszek T. Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? J Antimicrob Chemother. 2018; 73 (Suppl_2): ii2–10. doi: 10.1093/jac/dkx504pmid:29490062.

43. Tan S.H., Ng T.M., Tay H.L., Yap M.Y., Heng S.T., Loo A.Y.X. et al. A point prevalence survey to assess antibiotic prescribing in patients hospitalized with confirmed and suspected coronavirus disease 2019 (COVID-19). J Glob Antimicrob Resist. 2021 Mar; 24: 45–47. doi: 10.1016/j.jgar.2020.11.025.

44. Evans T.J., Davidson H.C., Low J.M., Basarab M., Arnold A. Antibiotic usage and stewardship in patients with COVID-19: too much antibiotic in uncharted waters? J Infect Prev. 2021 May; 22 (3): 119–125. doi: 10.1177/1757177420976813.

45. Zhu N., Aylin P., Rawson T.,Gilchrist M., Majeed A., Holmes A. Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves. Clin Microbiol Infect. 2021 Feb 16; 27 (5): 762–768. doi: 10.1016/j.cmi.2021.02.007.

46. Tsay S.V., Bartoces M., Gouin K., Kabbani S., Hicks L.A. Antibiotic Prescriptions Associat-ed With COVID-19 Outpatient Visits Among Medicare Beneficiaries, April 2020 to April 2021. JAMA. 2022; 327 (20): 2018–2019. doi: 10.1001/jama.2022.5471.

47. Peñalva G., Benavente R.S., Pérez-Moreno M.A., Pérez-Pacheco M.D., Pérez-Milena A., Murcia J. et al. Effect of the coronavirus disease 2019 pandemic on antibiotic use in primary care. Clin Microbiol Infect. 2021 Jul; 27 (7): 1058–1060. doi: 10.1016/j.cmi.2021.01.021.

48. King L.M., Lovegrove M.C., Shehab N., Tsay S., Budnitz D.S., Geller A.I. et al. Trends in US outpatient antibiotic prescriptions during the coronavirus disease 2019 pandemic. Clin Infect Dis. 2021 Aug 2; 73 (3): e652–e660. doi: 10.1093/cid/ciaa1896.

49. Кароли Н. А., Апаркина А. В., Григорьева Е. В., Магдеева Н. А., Никитина Н. М., Смирнова Н. Д., Ребров А. П. Антибактериальная терапия пациентов с COVID-19 на амбулаторном и стационарном этапах. Антибиотики и химиотер. 2022; 67: 1–2: 24–31. doi: 10.37489/0235-2990-2022-67-1-2-24-31.

50. Zavala-Flores E., Salcedo-Matienzo J. Medicación prehospitalaria en pacientes hospitalizados por COVID-19 en un hospital público de Lima-Perú. Acta Med Peru. 2020; 37. doi: 10.35663/amp.2020.373.1277.

51. Huttner B., Catho G., Pano-Pardo J.R., Pulcini C., Schouten J. COVID-19: don’t neglect antimicrobial stewardship principles! Clin Microbiol Infect 2020; 26 (7): 808–810. doi: 10.1016/j.cmi.2020.04.024.

52. Clancy C.J., Nguyen M.H. COVID-19, superinfections and antimicrobial development: what can we expect? Clin Infect Dis. 2020; 71 (10): 2736–2743. doi: 10.1093/cid/ciaa524.

53. National Institute for Health and Care Excellence (NICE). COVID-19 rapid guideline: antibiotics for pneumonia in adults in hospital [Internet]. 2021. Available from: https://www.nice.org.uk/guidance/ng173/chapter/4-Assessing-the-ongoing-need-for-antibiotics

54. Tamma P.D., Avdic E., Li D.X., Dzintars K., Cosgrove S.E. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med. 2017; 177 (9): 1308–1315. doi: 10.1001/jamainternmed.2017.1938.

55. Buetti N., Mazzuchelli T., Lo Priore E., Balmelli C., Llamas M., Pallanza M. et al. Early administered antibiotics do not impact mortality in critically ill patients with COVID-19. J Infect. 2020; 81 (2): e148–e149. doi: 10.1016/j.jinf.2020.06.004.

56. Cataño-Correa J.C., Cardona-Arias J.A., Porras Mancilla J.P., García M.T. Bacterial superinfec-tion in adults with COVID-19 hospitalized in two clinics in Medellín-Colombia, 2020. PLoS One. 2021 Jul 13; 16 (7): e0254671. doi: 10.1371/journal.pone.0254671.

57. Beović B., Doušak M., Ferreira-Coimbra J., Nadrah K., Rubulotta F.,Belliato M. et al. Antibiotic use in patients with COVID-19: a 'snapshot' Infectious Diseases International Research Initiative (ID-IRI) survey. J Antimicrob Chemother. 2020 Nov 1; 75 (11): 3386–3390. doi: 10.1093/jac/dkaa326.

58. Guan W.J., Ni Z.Y., Hu Y., Liang W.H., Ou C.Q., He J.X. et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 Apr 30; 382 (18): 1708–1720. doi: 10.1056/NEJMoa2002032.

59. Liu C., Wen Y., Wan W., Lei J., Jiang X. Clinical characteristics and antibiotics treatment in suspected bacterial infection patients with COVID-19. Int Immunopharmacol. 2021; 90: 107157. doi: 10.1016/j.intimp.2020.107157.

60. Adebisi Y.A., Jimoh N.D., Ogunkola I.O., Uwizeyimana T., Olayemi A.H., Ukor N.A. et al. The use of antibiotics in COVID-19 management: a rapid review of national treatment guidelines in 10 African countries. Trop Med Health. 2021 Jun 23; 49 (1): 51. doi: 10.1186/s41182-021-00344-w.

61. Lai C.C., Yu W.L. Appropriate use of antimicrobial therapy for COVID-19 co-infection. Immunotherapy. 2021 Sep;13 (13): 1067–1070. doi: 10.2217/imt-2021-0134.

62. Cao J., Tu W.J., Cheng W., Yu L., Liu Y.K., Hu X. et al. Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China. Clin Infect Dis. 2020 Jul 28; 71 (15): 748–755. doi: 10.1093/cid/ciaa243.

63. Ruiz-Bastián M., Falces-Romero I., Ramos-Ramos J.C., de Pablos M., García-Rodríguez J.; SARS-CoV-2 Working Group. Bacterial co-infections in COVID-19 pneumonia in a tertiary care hospital: surfing the first wave. Diagn Microbiol Infect Dis. 2021; 101 (3): 115477. doi: 10.1016/j.diag-microbio.2021.115477.

64. Vijay S.,Bansal N.,Rao B.K., Veeraraghavan B.,Rodrigues C.,Wattal C.et al. Secondary infections in hospitalized COVID-19 patients: indian experience. Infect Drug Resist. 2021 May 24; 14: 1893–1903. doi: 10.2147/IDR.S299774.

65. Rothe K., Feihl S., Schneider J., Wallnöfer F., Wurst M., Lukas M. et al. Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of antibiotic stewardship. Eur J Clin Microbiol Infect Dis. 2021 Apr; 40 (4): 859–869. doi: 10.1007/s10096-020-04063-8.

66. Yacouba A., Olowo-Okere A., Yunusa I. Repurposing of antibiotics for clinical management of COVID-19: a narrative review. Ann Clin Microbiol Antimicrob. 2021 May 21; 20 (1): 37. doi: 10.1186/s12941-021-00444-9.

67. Al-Kuraishy H.M., Al-Naimi M.S., Lungnier C.M., Al-Gareeb A.I. Macrolides and COVID-19: an optimum premise. Biomed Biotechnol Res J. 2020; 4: 189–192.

68. Mason J.W. Antimicrobials and QT prolongation. J Antimicrob Chemother. 2017; 72 (5): 1272–1274. doi: 10.1093/jac/dkw591.

69. Kim D.,Quinn J.,Pinsky B.,Shah N.H.,Brown I. Rates of co-infection between SARS-CoV-2 and other respiratory pathogens. JAMA. 2020 May 26; 323 (20): 2085–2086. doi: 10.1001/jama.2020.6266.

70. Goldstein E.J.C., Tillotson G., Redell M. Antimicrobial management of respiratory infections in severe acute respiratory syndrome coronavirus 2 patients: clinical and antimicrobial stewardship programs conundrums. Open Forum Infect Dis. 2020 Oct 26; 7 (11): ofaa517. doi: 10.1093/ofid/ofaa517.

71. Rizvi S.G., Ahammad S.Z. COVID-19 and antimicrobial resistance: A cross-study. Sci Total Environ. 2022 Feb 10; 807 (Pt 2): 150873. doi: 10.1016/j.scitotenv.2021.150873.

72. Gonzalez-Zorn B. Antibiotic use in the COVID-19 crisis in Spain. Clin Microbiol Infect. 2021 Apr; 27 (4): 646–647. doi: 10.1016/j.cmi.2020.09.055.

73. Dieringer T.D.,Furukawa D.,Graber C.J.,Stevens V.W.,Jones M.M.,Rubin M.A. et al. Inpatient antibiotic utilization in the Veterans' Health Administration during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol. 2021 Jun; 42 (6): 751–753. doi: 10.1017/ice.2020.1277.

74. Al-Azzam S., Mhaidat N.M., Banat H.A., Alfaour M., Ahmad D.S., Muller A. et al. An assessment of the impact of coronavirus disease (COVID-19) pandemic on national antimicrobial consumption in Jordan. Antibiotics 2021; 10: 690. doi: 10.3390/antibiotics10060690.

75. Andrews A., Budd E.L., Hendrick A., Ashiru-Oredope D.,Beech E.,Hopkins S. et al. Surveillance of antibacterial usage during the COVID-19 pandemic in England, 2020. Antibiotics (Basel). 2021 Jul 10; 10 (7): 841. doi: 10.3390/antibiotics10070841.

76. de Lusignan S., Joy M., Sherlock J., Tripathy M., van Hecke O., Gbinigie K. et al. Principle trial demonstrates scope for in-pandemic improvement in primary care antibiotic stewardship: a retrospective sentinel network cohort study. BJGP Open. 2021 Oct 26; 5 (5): BJGPO.2021.0087. doi: 10.3399/BJGPO.2021.0087.

77. Cultrera R., Barozzi A., Libanore M., Marangoni E., Pora R., Quarta B. et al. Co-infections in critically ill patients with or without COVID-19: a comparison of clinical microbial culture findings. Int J Environ Res Public Health. 2021 Apr 20; 18 (8): 4358. doi: 10.3390/ijerph18084358.

78. Winders H.R., Bailey P., Kohn J., Faulkner-Fennell C.M., Utley S., Lantz E. et al. Change in antimicrobial use during COVID-19 pandemic in South Carolina hospitals: a multicenter observational cohort study. Int J Antimicrob Agents. 2021 Dec; 58 (6): 106453. doi: 10.1016/j.ijantimicag.2021.106453.

79. Jeon K., Jeong S., Lee N., Park M.J., Song W., Kim H.S., Kim H.S., Kim J.S. Impact of COVID-19 on antimicrobial consumption and spread of multidrug-resistance in bacterial infections. Antibiotics (Basel). 2022 Apr 18; 11 (4): 535. doi: 10.3390/antibiotics11040535.

80. Карноух К.И., Лазарева Н.Б. Анализ потребления антибактериальных средств на фоне пандемии COVID-19: уровень стационара. Медицинский совет. 2021; 16: 118–128. doi: 10.21518/2079-701X-2021-16-118-128.

81. Khor W.P., Olaoye O., D'Arcy N., Krockow E.M., Elshenawy R.A., Rutter V. et al. The need for ongoing antimi-crobial stewardship during the COVID-19 pandemic and actionable recommendations. Antibiotics (Basel). 2020 Dec 14; 9 (12): 904. doi: 10.3390/antibiotics9120904.

82. Pelfrene E., Botgros R., Cavaleri M. Antimicrobial multidrug resistance in the era of COVID-19: a forgotten plight? Antimicrob Resist Infect Control. 2021 Jan 29; 10 (1): 21. doi: 10.1186/s13756-021-00893-z.

83. Scottish Antimicrobial Prescribing Group. Scottish Reduction in Antimicrobial Prescribing (ScRAP) https://www.nes.scot.nhs.uk/education-and-training/bythemeinitiative/healthcare-associated-infections/training-resources/scottishreduction-in-antimicrobial-prescribing-(scrap).aspx (accessed July 2021).

84. Sieswerda E., de Boer M.G.J., Bonten M.M.J., Boersma W.G., Jonkers R.E., Aleva R.M. et al. Recommendations for antibacterial therapy in adults with COVID-19 — an evidence based guideline. Clin Microbiol Infect. 2021 Jan; 27 (1): 61–66. doi: 0.1016/j.cmi.2020.09.041.

85. Guidance for the Use of Empiric Antibiotics in Inpatient COVID-19 Pneumonia (Updated 12/01/2020) https://www.nebraskamed.com/sites/default/files/documents/covid-19/guidance-on-antibiotic-use-in-covid-19.pdf

86. Pettit N.N., Nguyen C.T., Lew A.K., Bhagat P.H., Nelson A., Olson G. et al. Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission. BMC Infect Dis. 2021 Jun 2; 21 (1): 516. doi: 10.1186/s12879-021-06219-z.