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

Study Background and Research Question

The COVID-19 pandemic has placed unprecedented strain on healthcare systems worldwide, particularly in settings where vulnerable populations, such as psychiatric inpatients, are concentrated. Psychiatric hospitals face unique infection control challenges due to patients' impaired self-care, group activities, and the immunosuppressive effects of long-term psychotropic medication. These factors increase the risk of bacterial co-infections, making rational use of antibacterial agents critical for patient safety and public health. The study by Jiang et al. (Scientific Reports, 2025) addresses an important gap by systematically analyzing patterns of antibacterial drug use and the evolution of bacterial resistance in a psychiatric hospital during the 2022 epidemic. The central research question asks: How did antibacterial prescribing practices during the COVID-19 pandemic influence bacterial resistance profiles in a psychiatric hospital, and what lessons can be drawn for future stewardship?

Key Innovation from the Reference Study

The study’s principal innovation lies in its focused evaluation of both antibiotic usage and resistance trends within a psychiatric hospital context during a pandemic year, supported by robust data collection from hospital information systems and national surveillance networks. Unlike previous reports that aggregate data across more generalized healthcare settings, this research isolates the unique epidemiological and behavioral factors at play in psychiatric institutions, offering actionable stewardship insights tailored to this environment. The use of comprehensive, retrospective data enables nuanced benchmarking against both provincial and national standards, highlighting areas of both strength and ongoing vulnerability.

Methods and Experimental Design Insights

Jiang et al. employed a retrospective study design, drawing on multiple data sources for a comprehensive analysis. Data on antibacterial drug use in 2022 were extracted from the National Antibacterial Drug Clinical Application Monitoring Network and the hospital’s information system. Key metrics included:

• Antibiotic use rate (percentage of patients receiving antibiotics)
• Antibiotic usage intensity (AUD)
• Combined medication rate
• Cumulative defined daily doses (DDDs)
• Proportion of antibiotic costs relative to overall drug expenses
• Rate of microbiological submission for antibacterial drug use
• Bacterial species distribution and antimicrobial resistance patterns

The study focused on commonly used antibiotics—third-generation cephalosporins, penicillins, and quinolones—while also categorizing resistance patterns for both Gram-negative and Gram-positive organisms. Microbiological submission rates were compared to regional and national averages, providing additional context for stewardship assessment.

Core Findings and Why They Matter

According to the reference study, the 2022 antibiotic use rate in the psychiatric hospital was 5.00%, with a usage intensity of 3.07 and a combined medication rate of 11.11%. The cumulative DDDs reached 12,039.04, while antibiotic costs accounted for just 3.95% of total drug expenses. These metrics are notably lower than those reported for Jiangsu Province and China overall, suggesting prudent antibiotic stewardship within this psychiatric facility.

However, the rate of microbiological submission for antibiotic prescription was 77.78%, exceeding both provincial and national benchmarks—an encouraging sign of evidence-based prescribing and infection monitoring. The primary antibiotics used were cefodizime, amoxicillin, and piperacillin–tazobactam.

Despite these strengths, the study identified that Gram-negative bacteria exhibited significant resistance to commonly used agents, particularly penicillins, cephalosporins, and quinolones such as ampicillin, amoxicillin–clavulanic acid, ceftazidime, ceftriaxone, amikacin, and ciprofloxacin. Gram-positive bacteria showed resistance especially to penicillins, macrolides, and quinolones, with pronounced resistance to penicillin, benzylpenicillin, erythromycin, levofloxacin, and ciprofloxacin. These data underscore a concerning link between increased antibiotic use—even if rational and relatively limited—and the evolution of resistance, with direct implications for treatment efficacy and patient prognosis.

The study concludes that continuous monitoring and regular data analysis are essential to optimize antibiotic use and minimize the development of resistant strains, ultimately supporting improved healthcare outcomes in psychiatric hospitals.

Comparison with Existing Internal Articles

Recent internal resources, such as “Gamma-Linolenic Acid (GLA): Advancing Translational Inflammation Research” and “Gamma-linolenic Acid (GLA): Immunomodulation and LTB4 Receptor Inhibition,” focus on the mechanistic and translational potential of GLA as an anti-inflammatory agent and weak leukotriene B4 receptor antagonist. While these articles primarily address inflammation and immune modulation in disease models, they resonate with the reference study in terms of addressing inflammation-driven pathologies exacerbated by bacterial infection and antibiotic resistance.

For example, the internal literature highlights the value of GLA in anti-inflammatory research and apoptosis assays, suggesting a complementary strategy in settings where inflammation and infection intersect. The reference study’s emphasis on optimizing antimicrobial stewardship aligns with the need for robust anti-inflammatory tools, such as GLA, to mitigate complications arising from bacterial resistance, especially in immunocompromised populations like psychiatric inpatients.

Limitations and Transferability

While the study offers detailed insights into antibacterial use and resistance at a single psychiatric hospital, its retrospective design limits causal inference. The findings are most directly transferable to similar institutional settings with comparable patient demographics and infection control protocols. Variability in hospital infrastructure, patient management, and regional bacterial ecology may influence generalizability. Additionally, the study does not address the potential role of adjunct anti-inflammatory strategies—such as the use of omega-6 fatty acids like GLA—in modulating infection-driven inflammation or supporting antibiotic stewardship. Future prospective, multicenter studies are warranted to validate and extend these findings.

Protocol Parameters

• Data extraction timeframe: Calendar year 2022; align data collection with epidemic periods for accurate benchmarking.
• Metrics for surveillance: Include antibiotic use rate, usage intensity (AUD), combined medication rate, DDDs, and microbiological submission rates in regular stewardship reports.
• Bacterial resistance monitoring: Perform species-specific resistance profiling for both Gram-negative and Gram-positive isolates, with periodic review against regional/national data.
• Clinical decision support: Implement protocols for microbiological submission before starting or escalating antibiotics to ensure data-driven prescribing.
• Translational research crossover: When modeling infection-inflammation interplay, consider integrating anti-inflammatory agents such as GLA into experimental workflows to explore adjunctive effects (see internal GLA literature for protocol inspiration).

Research Support Resources

For researchers aiming to model infection, inflammation, or antibiotic resistance in psychiatric or related settings, leveraging high-purity anti-inflammatory agents can be instrumental. Gamma-linolenic acid (GLA) (SKU C5518) from APExBIO is widely used in anti-inflammatory research, apoptosis assays, and studies on immune signaling. Its mechanistic profile as a weak leukotriene B4 receptor antagonist and its documented safety make it a practical tool for exploring adjunctive strategies alongside antimicrobial stewardship. For optimal protocol design, consult both the reference study and relevant internal resources for benchmarking and workflow development.