Michael Pulia awarded $2.4 million grant to study impact of COVID-19 on antibiotic prescribing and bacterial resistance

Michael Pulia, MD, MS will lead a major $2.4 million five-year research grant from the Agency for Healthcare Research and Quality (AHRQ) titled “Characterizing the ImPact of COVID-19 on Antibiotic PreScribing in AcutE Care and IDentifying Resilient Stewardship Strategies (POISED).”

The ongoing COVID-19 pandemic has resulted in more than 47 million infections in the U.S. and continues to overwhelm healthcare systems across the country. The novel nature of COVID-19 has generated unprecedented diagnostic and therapeutic dilemmas, including those related to the optimal use of antibiotic therapy.

One area of significant concern among medical experts is the impact of the COVID-19 pandemic on antibiotic prescribing more broadly and an associated acceleration of bacterial resistance. Antibiotics are unique therapeutic agents in that they decrease in effectiveness over time as bacteria develop resistance. Inappropriate or unnecessary antibiotic prescribing in healthcare and agricultural settings can accelerate this process. Antibiotic stewardship, defined as efforts to improve how antibiotics are prescribed in healthcare settings, is one of the key tools to curb the further development of bacterial resistance.

Antibiotic resistance has long been described by health experts as “the silent pandemic”. According to the Centers for Disease Control and Prevention (CDC), at least 2.8 million people in the U.S. are infected with antibiotic-resistant infections each year, and more than 35,000 people die as a result. The CDC also estimates that the national cost to treat infections caused by the germs most frequently found in health care is substantial—more than $4.6 billion annually. The extent to which the unprecedented stress to the healthcare system caused by COVID-19 has already and will continue to impact antibiotic prescribing and trends in bacterial resistance in the years to come is unknown.

As such, Dr. Pulia’s research team will measure the impact of COVID-19 on overall and condition specific antibiotic prescribing and bacterial resistance patterns in acute care settings using data from a diverse, nationally representative group of approximately 300 U.S. hospitals. Then, using a systems engineering-guided approach, the team will interview frontline healthcare providers and stewardship teams to characterize the factors underlying observed hospital antibiotic prescribing patterns and trends. These results will be used to develop an implementation toolkit for U.S.-based hospitals that will outline effective strategies to enhance antibiotic stewardship resiliency during operational upheaval.

To make this project successful, Dr. Pulia will partner with an accomplished, interdisciplinary team of co-investigators and collaborators. Dr. Peter Lindenauer, Director, Institute for Healthcare Delivery and Population Science at the University of Massachusetts-Baystate, and Dr. Penny Pekow, Supervisor of Biostatistics and Research Support, Baystate Medical Center, will provide expertise for the aim focused on analyzing antibiotic prescribing and bacterial resistance patterns.

UW collaborators include Dr. Nicole Werner, Director, UW Institute for Healthcare Systems Engineering, to conduct human factors/systems engineering informed analyses to develop a ‘resilient’ antibiotic stewardship toolkit; Dr. Aurora Pop-Vicas, Assistant Professor in the Department of Medicine, Division of Infectious Diseases whose research focuses on the epidemiology of hospital-acquired infections from drug-resistant bacteria; and Dr. Lucas Schulz, Clinical Coordinator for Infectious Diseases at UW Health, a nationally recognized pharmacist and researcher in the area of antibiotic stewardship.

Finally, Dr. Arjun Srinivasan, Associate Director for Healthcare-Associated Infections (HAI) Prevention Programs in the Division of Healthcare Quality Promotion at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, and Dr. Melinda Neuhauser, Pharmacist and Acute Care Lead for the CDC’s Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion, will be serving as advisors on the project.

On receiving news of the award, Dr. Pulia said, “I am incredibly excited to work with this accomplished group of collaborators to address the impact of COVID-19 on the longstanding scourge of bacterial resistance. Our team is ideally positioned to characterize pandemic-related, national trends in antibiotic prescribing and resistance. These findings will be leveraged to identify what worked and what did not in terms of antibiotic stewardship from a work system perspective. We are poised to learn critical and time-sensitive lessons about how to build resiliency into hospital antibiotic stewardship efforts.”

With only about 5% of all submissions for AHRQ R01 grants typically funded, this successful award represents a major milestone for Dr. Pulia in his career as a physician scientist, as well as for the BerbeeWalsh Department of Emergency Medicine. This work represents a vital contribution to the AHRQ’s ongoing efforts to combat both COVID-19 and the longstanding pandemic of antimicrobial-resistant infections.