Antibacterial Drug Use and Bacterial Resistance in Psychiatric Hospitals During the COVID-19 Epidemic

Study Background and Research Question

The COVID-19 pandemic has presented unprecedented challenges to healthcare systems globally, particularly in specialized settings such as psychiatric hospitals. Psychiatric inpatients face unique risks for infection due to factors including impaired self-care, immunosuppression from psychotropic medications, and the inherently communal nature of care. The study by Jiang et al. addresses a critical gap: how did antibacterial drug use and bacterial resistance patterns shift in a psychiatric hospital during the epidemic, and what lessons can be drawn to optimize stewardship and infection control in similar institutions?

Key Innovation from the Reference Study

The principal innovation of Jiang et al.'s work lies in its focused, data-driven evaluation of antibacterial consumption and resistance dynamics within a psychiatric care context during a public health emergency. Unlike previous studies that typically aggregate data from general hospitals, this research provides granular insight into the prescribing patterns, microbiological surveillance, and resistance rates unique to psychiatric institutions. By benchmarking their data against both provincial (Jiangsu) and national trends, the authors reveal that their hospital maintained notably lower antibiotic use rates and costs, yet faced rising resistance among both Gram-negative and Gram-positive bacteria. This dual perspective—on stewardship success and emerging resistance—offers actionable guidance for similar facilities worldwide.

Methods and Experimental Design Insights

The study adopts a retrospective approach, systematically collecting administrative and microbiological data for the year 2022. Key metrics analyzed include:

• Antibiotic use rate: The percentage of inpatients receiving at least one antibacterial drug.
• Usage intensity (AUD): Defined daily doses per 100 patient days, providing a standardized measure of antibiotic consumption.
• Combined medication rate: The proportion of patients receiving multiple antibiotics.
• Cumulative DDDs: The total number of defined daily doses administered over the year.
• Cost analysis: Antibiotic expenditure as a proportion of total drug costs.
• Microbiological submission rate: Frequency of pathogen sampling and testing relative to antibiotic prescribing events.
• Resistance profiling: Identification of pathogens and assessment of drug susceptibility, focusing on both Gram-negative and Gram-positive organisms.

Data were retrieved via the hospital’s information system and supplemented with records from the National Antibacterial Drug Clinical Application Monitoring Network, enabling robust cross-comparison with regional and national benchmarks.

Core Findings and Why They Matter

Jiang et al. reported several noteworthy findings:

• Antibiotic use rate: 5.00% — significantly lower than both provincial and national averages.
• Usage intensity: 3.07 — reflecting restrained prescribing behavior.
• Antibiotic costs: Comprised only 3.95% of total drug expenditure.
• Microbiological submission rate: 77.78%, which is substantially higher than comparator institutions, indicating strong adherence to diagnostic stewardship.
• Main antibiotics: Third-generation cephalosporins, penicillins, and quinolones—with cefodizime, amoxicillin, and piperacillin–tazobactam most frequently used.
• Resistance trends: Gram-negative bacteria showed resistance primarily to penicillins, cephalosporins, and quinolones (notably ampicillin, amoxicillin–clavulanic acid, ceftazidime, ceftriaxone, amikacin, ciprofloxacin). Gram-positive bacteria resisted penicillins, macrolides, and quinolones (notably penicillin, benzylpenicillin, erythromycin, levofloxacin, ciprofloxacin).

These findings underscore a paradox: despite exemplary stewardship in terms of lower usage and higher diagnostic sampling, bacterial resistance rates continued to rise. This suggests that factors intrinsic to the psychiatric hospital environment—such as closed management systems, group activities, and patient comorbidities—may drive transmission and selection of resistant strains independently of overall antibiotic consumption. The study therefore advocates for intensified resistance monitoring and regular review of susceptibility data, as well as tailored stewardship strategies for the psychiatric setting.

Comparison with Existing Internal Articles

While Jiang et al.’s study centers on antibacterial drug stewardship and resistance surveillance, internal resources such as "QNZ (EVP4593): Potent Quinazoline NF-κB Inhibitor for Preclinical Research" and "Elite NF-κB Inhibitor for Inflammation & Neurodegeneration" focus on molecular tools for dissecting inflammation and neurodegenerative disease mechanisms. QNZ (EVP4593) is highlighted as a highly selective NF-κB signaling pathway modulator, with applications in both anti-inflammatory compound screening and neurodegenerative disease models such as Huntington’s disease research. While the mechanisms differ—antibacterial drugs target specific pathogens, whereas QNZ influences host inflammatory responses—the two domains intersect in the broader context of hospital-acquired infections, where dysregulated immunity and inflammation contribute to both infection susceptibility and disease progression. Researchers aiming to model the inflammatory consequences of bacterial infection or to study host–pathogen interactions may find synergy by integrating resistance surveillance data with pathway-specific inhibitors, as described in the internal resources.

Limitations and Transferability

There are several limitations to consider:

• Single-center design: Results may not generalize to all psychiatric hospitals, especially those with different patient populations, infrastructure, or stewardship resources.
• Retrospective data collection: While comprehensive, the approach may miss temporal trends or causal relationships not captured in administrative records.
• Lack of intervention arm: The study does not test specific interventions to reduce resistance, but rather documents trends and associations.

Nonetheless, the methodology and findings offer a valuable template for psychiatric hospitals globally, especially those seeking to balance effective infection control with stewardship imperatives.

Protocol Parameters

• Antibiotic use rate calculation: Number of patients receiving antibiotics divided by total inpatient admissions over a defined period.
• Usage intensity (AUD): Expressed as defined daily doses per 100 patient-days, facilitating cross-institutional comparison.
• Microbiological submission best practices: Aim for >75% of antibiotic prescriptions to be accompanied by pathogen sampling and susceptibility testing, as achieved in the reference study.
• Resistance monitoring: Conduct quarterly reviews of pathogen-specific resistance rates to inform empirical therapy guidelines.
• Data integration: Use hospital information systems and national monitoring networks to consolidate prescribing, microbiology, and resistance data streams.

Research Support Resources

For researchers interested in complementing antibacterial stewardship studies with host pathway modulation or anti-inflammatory compound screening, QNZ (EVP4593) (SKU A4217) is available via APExBIO. This potent quinazoline derivative NF-κB inhibitor is recognized for its nanomolar efficacy and established utility in inflammation and neurodegenerative disease models. Its robust solubility and performance in both cell and animal assays support a range of experimental workflows. Researchers can refer to internal reviews for protocol guidance and integration with resistance and infection models.