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Elsafi SH, Almutairi SH, Alsulaimani MA, AlBahrani S, Al-Maqati TN, Alanazi WK, Alanazi MN, Alamri AA, Alkhathami MH, Alshammari RA, Alharbi NF, Al Naam YA. The Trend of Antibiotic Consumption After the COVID-19 Pandemic: Approach to Future Outbreaks. Infect Drug Resist 2024; 17:2227-2236. [PMID: 38854778 PMCID: PMC11162212 DOI: 10.2147/idr.s460148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024] Open
Abstract
Background Earlier reports suggested high rates of antibiotic utilization among COVID-19 patients despite the lack of direct evidence of their activity against viral pathogens. Different trends in antibiotic consumption during 2020 compared to 2019 have been reported. Purpose The objective of this study is to assess the impact of COVID-19 pandemic on antibiotic consumption in the presence of active Antibiotic Stewardship Program. Methods This study represented a five years assessment of the consumption of the commonly prescribed antibiotics measured as DDDs/100-Bed Days. We analyzed the data by using nonparametric Friedman and Friedman tests to compare the antibiotic consumption before and during the three subsequent waves of COVID-19. Results Antibiotic consumption through the DDDs/100-BD has shown reduction in the median of antibiotics consumption of most antibiotics during the period of COVID-19 as compared to the pre-COVID-19 period, which was significant for meropenem and ciprofloxacin, except colomycin that slightly increased. Significant reduction in the consumption of imipenem and meropenem during the second and third waves as compared to the pre-COVID period. Throughout the years, significant reductions were observed between 2018 and 2019 (p=<.001), 2018 and 2020 (p=0.008), and 2018 and 2022 (p=0.002). Conclusion The reduction in antibiotic consumption is attributed to the strong influence if the ASP and the reluctance of people to visit hospitals during the COVID-19 pandemic. Other related COVID-19 precautions such as physical distance, good hand hygiene, facemasks, that resulted in the prevention of secondary bacterial infections have contributed to the reduction in antibiotic utilization during the pandemic.
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Affiliation(s)
- Salah H Elsafi
- Clinical Laboratory Sciences. Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Saleh H Almutairi
- Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Mujahid A Alsulaimani
- Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Salma AlBahrani
- Infectious Disease Unit, Specialty Internal Medicine, King Fahhd Military Medical Complex, Dhahran Saudi Arabia; College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudia Arabia
| | - Thekra N Al-Maqati
- Clinical Laboratory Sciences. Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Wafa K Alanazi
- Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Mohammed N Alanazi
- Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Abdullah A Alamri
- Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Majed Hamoud Alkhathami
- Department of Support Services, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Rakkad A Alshammari
- Department of Support Services, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Naif F Alharbi
- Department of Support Services, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Yaser A Al Naam
- Clinical Laboratory Sciences. Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
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Chanapal A, Cheng HY, Lambert H, Cong W. Antibiotic prescribing and bacterial infection in COVID-19 inpatients in Southeast Asia: a systematic review and meta-analysis. JAC Antimicrob Resist 2024; 6:dlae093. [PMID: 38863558 PMCID: PMC11166085 DOI: 10.1093/jacamr/dlae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/24/2024] [Indexed: 06/13/2024] Open
Abstract
Background The prescribing of antibiotics to treat COVID-19 patients has been observed to occur frequently, often without clear justification. This trend raises concerns that it may have exacerbated antimicrobial resistance (AMR). Despite longstanding concerns over AMR in Southeast Asian countries, data on this issue are notably lacking. Objectives To explore the impact of COVID-19 on antibiotic prescribing, bacterial infection prevalence and common resistant pathogens in COVID-19 inpatients. Methods We searched PubMed, EMBASE, Web of Science and ThaiJO (a Thai academic database) to identify studies conducted in ASEAN member countries and published between December 2019 and March 2023. Screening and data extraction were done by two independent reviewers, with results synthesized using random-effects meta-analyses and descriptive statistical analyses. This review was registered with PROSPERO (CRD42023454337). Results Of the 29 studies (19 750 confirmed COVID-19 cases) included for final analysis, the antibiotic prescribing rate was 62.0% (95%CI: 46.0%-76.0%) with a prescribing rate of 58.0% (21.0%-91.0%) in mild/moderate cases versus 91.0% (82.0%-98.0%) in severe/critical cases. Notably, 80.5% of antibiotics prescribed fall under the WHO AWaRe 'Watch' list, followed by 'Access' at 18.4% and 'Reserve' at 1.0%. The reported bacterial infection prevalence was 16.0% (7.0%-29.0%), with Acinetobacter baumannii being the most common resistant bacterium at 7.7%. Singapore was notable for its lower antibiotic prescribing rate of 17.0% and a lower bacterial infection rate of 10.0%. Conclusions High antibiotic prescribing rates, disproportionate to bacterial infections and varying practices for COVID-19 inpatients across countries highlight the urgent need for this region to collaborate to tackle and mitigate AMR.
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Affiliation(s)
- Achiraya Chanapal
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
- School of Medicine, University of Phayao, Phayao 56000, Thailand
| | - Hung-Yung Cheng
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Helen Lambert
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Wenjuan Cong
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
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Ng TM, Ang LW, Heng ST, Kwa ALH, Wu JE, Seah XFV, Lee SY, Seah J, Choo R, Lim PL, Thoon KC, Chlebicki MP, Somani J, Lee TH, Lye DC. Antibiotic utilisation and resistance over the first decade of nationally funded antimicrobial stewardship programmes in Singapore acute-care hospitals. Antimicrob Resist Infect Control 2023; 12:82. [PMID: 37612738 PMCID: PMC10464409 DOI: 10.1186/s13756-023-01289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe the time series of broad-spectrum antibiotic utilisation and incidence of antibiotic-resistant organisms during the implementation of antimicrobial stewardship programmes (ASP) in Singapore. METHODS An observational study was conducted using data from 2011 to 2020 in seven acute-care public hospitals. We applied joinpoint regressions to investigate changes in antibiotic utilisation rate and incidence density of antibiotic-resistant organisms. RESULTS Across the seven hospitals, quarterly broad-spectrum antibiotic utilisation rate remained stable. Half-yearly incidence density of antibiotic-resistant organisms with two joinpoints at first half (H1) of 2012 and second half (H2) of 2014 decreased significantly in the second and third period with a half-yearly percentage change (HPC) of -2.9% and - 0.5%, respectively. Across the five hospitals with complete data, half-yearly broad-spectrum antibiotic utilisation rate with one joinpoint decreased significantly from H1 of 2011 to H2 of 2018 (HPC - 4.0%) and H2 of 2018 to H2 2020 (HPC - 0.5%). Incidence density of antibiotic-resistant organisms decreased significantly in the two joinpoint periods from H1 of 2012 to H2 of 2014 (HPC - 2.7%) and H2 of 2014 to H2 of 2020 (HPC - 1.0%). Ceftriaxone with one joinpoint decreased significantly from H1 of 2011 to H1 of 2014 (HPC - 6.0%) and H1 of 2014 to H2 of 2020 (HPC - 1.8%) and ceftriaxone-resistant E. coli and K. pneumoniae decreased significantly in later periods, from H2 of 2016 to H2 of 2020 (HPC - 2.5%) and H1 of 2012 to H2 of 2015 (HPC - 4.6%) respectively. Anti-pseudomonal antibiotics with one joinpoint decreased significantly from H1 of 2011 to H2 of 2014 (HPC - 4.5%) and H2 of 2014 to H2 of 2020 (HPC - 0.8%) and that of quinolones with one joinpoint at H1 of 2015 decreased significantly in the first period. C. difficile with one joinpoint increased significantly from H1 of 2011 to H1 of 2015 (HPC 3.9%) and decreased significantly from H1 of 2015 to H2 of 2020 (HPC - 4.9%). CONCLUSIONS In the five hospitals with complete data, decrease in broad-spectrum antibiotic utilisation rate was followed by decrease in incidence density of antibiotic-resistant organisms. ASP should continue to be nationally funded as a key measure to combat antimicrobial resistance in acute care hospitals.
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Affiliation(s)
- Tat Ming Ng
- Tan Tock Seng Hospital, Singapore, Singapore.
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore, Singapore
- Ministry of Health, Singapore, Singapore
| | | | - Andrea Lay-Hoon Kwa
- Singapore General Hospital, Singapore, Singapore
- Duke- National University of Singapore Medical School, Singapore, Singapore
| | - Jia En Wu
- National University Hospital, Singapore, Singapore
| | | | | | | | - Robin Choo
- Ng Teng Fong General Hospital, Singapore, Singapore
| | - Poh Lian Lim
- Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Ministry of Health, Singapore, Singapore
| | - Koh Cheng Thoon
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke- National University of Singapore Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | | | - Jyoti Somani
- National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Tau Hong Lee
- Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
| | - David C Lye
- Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
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Patel TS, McGovern OL, Mahon G, Osuka H, Boszczowski I, Munita JM, Garzon MI, Salomao MC, Marssola G, Tavares BM, Francisco DB, Gurgel APA, Arantes T, Bori A, Nogueira C, Peters A, Spencer M, Orellana C, Barbe M, Lopez C, Stender S, Lessa FC. Trends in Inpatient Antibiotic Use Among Adults Hospitalized During the Coronavirus Disease 2019 Pandemic in Argentina, Brazil, and Chile, 2018-2021. Clin Infect Dis 2023; 77:S4-S11. [PMID: 37406043 DOI: 10.1093/cid/ciad261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND High rates of antibiotic use (AU) among inpatients with coronavirus disease 2019 (COVID-19) despite low rates of bacterial coinfection and secondary infection have been reported. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in South America. METHODS We conducted an ecologic evaluation of AU in inpatient adult acute care wards in 2 HCFs each in Argentina, Brazil, and Chile. The AU rates for intravenous antibiotics were calculated as the defined daily dose per 1000 patient-days, using pharmacy dispensing records and hospitalization data from March 2018-February 2020 (prepandemic) and March 2020-February 2021 (pandemic). Differences in median AU were compared between the prepandemic and pandemic periods, using the Wilcoxon rank sum test to determine significance. Interrupted time series analysis was used to analyze changes in AU during the COVID-19 pandemic. RESULTS Compared with the prepandemic period, the median difference in AU rates for all antibiotics combined increased in 4 of 6 HCFs (percentage change, 6.7%-35.1%; P < .05). In the interrupted time series models, 5 of 6 HCFs had significant increases in use of all antibiotics combined immediately at the onset of the pandemic (immediate effect estimate range, 15.4-268), but only 1 of these 5 HCFs experienced a sustained increase over time (change in slope, +8.13; P < .01). The effect of the pandemic onset varied by antibiotic group and HCF. CONCLUSIONS Substantial increases in AU were observed at the beginning of the COVID-19 pandemic, suggesting the need to maintain or strengthen antibiotic stewardship activities as part of pandemic or emergency HCF responses.
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Affiliation(s)
- Twisha S Patel
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chenega Enterprise Systems and Solutions Chesapeake, Virginia, USA
| | - Olivia L McGovern
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Garrett Mahon
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CACI International, Reston, Virginia, USA
| | - Hanako Osuka
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chenega Enterprise Systems and Solutions Chesapeake, Virginia, USA
| | - Icaro Boszczowski
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Jose M Munita
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Maria Isabel Garzon
- Servicio de Infectología, Hospital Privado de Córdoba, Cordoba, Argentina
- Hospital Español, Córdoba, Argentina
| | - Matias C Salomao
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | | | - Bruno M Tavares
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Tiago Arantes
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | - Andrea Bori
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | | | - Anne Peters
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Maria Spencer
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Cristian Orellana
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Mario Barbe
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | | | - Fernanda C Lessa
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Solanky D, McGovern OL, Edwards JR, Mahon G, Patel TS, Lessa FC, Hicks LA, Patel PK. Prescribing of Outpatient Antibiotics Commonly Used for Respiratory Infections Among Adults Before and During the Coronavirus Disease 2019 Pandemic in Brazil. Clin Infect Dis 2023; 77:S12-S19. [PMID: 37406052 DOI: 10.1093/cid/ciad183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic may have impacted outpatient antibiotic prescribing in low- and middle-income countries such as Brazil. However, outpatient antibiotic prescribing in Brazil, particularly at the prescription level, is not well-described. METHODS We used the IQVIA MIDAS database to characterize changes in prescribing rates of antibiotics commonly prescribed for respiratory infections (azithromycin, amoxicillin-clavulanate, levofloxacin/moxifloxacin, cephalexin, and ceftriaxone) among adults in Brazil overall and stratified by age and sex, comparing prepandemic (January 2019-March 2020) and pandemic periods (April 2020-December 2021) using uni- and multivariate Poisson regression models. The most common prescribing provider specialties for these antibiotics were also identified. RESULTS In the pandemic period compared to the prepandemic period, outpatient azithromycin prescribing rates increased across all age-sex groups (incidence rate ratio [IRR] range, 1.474-3.619), with the greatest increase observed in males aged 65-74 years; meanwhile, prescribing rates for amoxicillin-clavulanate and respiratory fluoroquinolones mostly decreased, and changes in cephalosporin prescribing rates varied across age-sex groups (IRR range, 0.134-1.910). For all antibiotics, the interaction of age and sex with the pandemic in multivariable models was an independent predictor of prescribing changes comparing the pandemic versus prepandemic periods. General practitioners and gynecologists accounted for the majority of increases in azithromycin and ceftriaxone prescribing during the pandemic period. CONCLUSIONS Substantial increases in outpatient prescribing rates for azithromycin and ceftriaxone were observed in Brazil during the pandemic with prescribing rates being disproportionally different by age and sex. General practitioners and gynecologists were the most common prescribers of azithromycin and ceftriaxone during the pandemic, identifying them as potential specialties for antimicrobial stewardship interventions.
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Affiliation(s)
- Dipesh Solanky
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Olivia L McGovern
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan R Edwards
- Surveillance Branch, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Garrett Mahon
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CACI International Inc., Reston, Virginia, USA
| | - Twisha S Patel
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chenega Enterprise Systems and Solutions, Chesapeake, Virginia, USA
| | - Fernanda C Lessa
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauri A Hicks
- Prevention and Response Branch, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Payal K Patel
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA
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6
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Nasr ZG, Elamin W, Basil M, Eljaaly K. Pharmacist-driven antimicrobial stewardship interventions in patients with COVID-19: a scoping review. Int J Clin Pharm 2023:10.1007/s11096-023-01574-0. [PMID: 37162655 PMCID: PMC10171144 DOI: 10.1007/s11096-023-01574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/09/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) is a highly infectious disease that can be treated with antivirals in addition to other antimicrobials in cases of secondary or concomitant infections. This creates potential for antimicrobials misuse, which increases antimicrobial resistance (AMR). Pharmacists are known to undertake prominent roles in combatting AMR. AIM The aim of this review was to characterize pharmacist-driven interventions that have been performed in patients with COVID-19 globally and describe their impact on antimicrobial use. METHOD We followed the Joanna Briggs Institutes manual framework for scoping reviews in our study. Studies that reported antimicrobial stewardship (AMS) interventions performed by pharmacists in COVID-19 patients were included. Articles that did not report outcomes or did not mention pharmacists in the intervention were excluded. Restrictions included English-only articles from inception date until June 2022. Articles were searched from four databases. RESULTS Eleven publications were included in the review. The most common AMS intervention was pharmacist-driven interventions reported in 63.2% of all studies, followed by guideline development and application (26.3%), and medication supply coordination (10.5%), respectively. The outcomes of the interventions were difficult to compare but showed a reduction in antimicrobial use and prevention of adverse drug reactions with a relatively high acceptance rate from physicians. CONCLUSION Pharmacists played an important role in performing AMS-related interventions in COVID-19 patients and helped in the fight against the worsening of AMR during the pandemic. The impact of pharmacist-driven AMS interventions in patients with COVID-19 seemed to be positive and improved outcomes related to antimicrobial use.
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Affiliation(s)
- Z G Nasr
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - W Elamin
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - M Basil
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - K Eljaaly
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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Koh SWC, Lee VME, Low SH, Tan WZ, Valderas JM, Loh VWK, Sundram M, Hsu LY. Prescribing Antibiotics in Public Primary Care Clinics in Singapore: A Retrospective Cohort Study. Antibiotics (Basel) 2023; 12:antibiotics12040762. [PMID: 37107127 PMCID: PMC10135213 DOI: 10.3390/antibiotics12040762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Antibiotic prescription practices in primary care in Singapore have received little scholarly attention. In this study, we ascertained prescription prevalence and identified care gaps and predisposing factors. METHODS A retrospective study was conducted on adults (>21 years old) at six public primary care clinics in Singapore. Prescriptions >14 days were excluded. Descriptive statistics were used to showcase the prevalence data. We used chi-square and logistic regression analyses to identify the factors affecting care gaps. RESULTS A total of 141,944 (4.33%) oral and 108,357 (3.31%) topical antibiotics were prescribed for 3,278,562 visits from 2018 to 2021. There was a significant reduction in prescriptions (p < 0.01) before and after the pandemic, which was attributed to the 84% reduction in prescriptions for respiratory conditions. In 2020 to 2021, oral antibiotics were most prescribed for skin (37.7%), genitourinary (20.2%), and respiratory conditions (10.8%). Antibiotic use in the "Access" group (WHO AWaRe classification) improved from 85.6% (2018) to 92.1% (2021). Areas of improvement included a lack of documentation of reasons for antibiotic use, as well as inappropriate antibiotic prescription for skin conditions. CONCLUSION There was a marked reduction in antibiotic prescriptions associated with the onset of the COVID-19 pandemic. Further studies could address the gaps identified here and evaluate private-sector primary care to inform antibiotic guidelines and the local development of stewardship programs.
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Affiliation(s)
- Sky Wei Chee Koh
- National University Polyclinics, National University Health System, Singapore 609606, Singapore
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Vivien Min Er Lee
- National University Polyclinics, National University Health System, Singapore 609606, Singapore
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Si Hui Low
- National University Polyclinics, National University Health System, Singapore 609606, Singapore
| | - Wei Zhi Tan
- National University Polyclinics, National University Health System, Singapore 609606, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore
| | - José María Valderas
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Victor Weng Keong Loh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Meena Sundram
- National University Polyclinics, National University Health System, Singapore 609606, Singapore
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
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Lontsi Ngoula G, Houcke S, Matheus S, Nkontcho F, Pujo JM, Higel N, Ba A, Cook F, Gourjault C, Mounier R, Nacher M, Demar M, Djossou F, Hommel D, Kallel H. Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana. Antibiotics (Basel) 2022; 12:58. [PMID: 36671259 PMCID: PMC9855120 DOI: 10.3390/antibiotics12010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
(1) Background: During the COVID-19 outbreak, several studies showed an increased prevalence of extended-spectrum β-lactamase producing Enterobacterales (ESBL-PE) carriage in intensive care units (ICUs). Our objective was to assess the impact of antibiotic prescriptions on the acquisition of ESBL-PE in ICUs during the COVID-19 crisis. (2) Methods: We conducted an observational study between 1 April 2020, and 31 December 2021, in the medical-surgical ICU of the Cayenne General Hospital. We defined two periods: Period 1 with routine, empirical antibiotic use, and Period 2 with no systematic empiric antibiotic prescription. (3) Results: ICU-acquired ESBL-PE carriage was 22.8% during Period 1 and 9.4% during Period 2 (p = 0.005). The main isolated ESBL-PE was Klebsiella pneumoniae (84.6% in Period 1 and 58.3% in Period 2). When using a generalized linear model with a Poisson family, exposure to cefotaxime was the only factor independently associated with ESBL-PE acquisition in ICU (p = 0.002, IRR 2.59 (95% IC 1.42-4.75)). The propensity scores matching estimated the increased risk for cefotaxime use to acquire ESBL-PE carriage at 0.096 (95% CI = 0.02-0.17), p = 0.01. (4) Conclusions: Exposure to cefotaxime in patients with severe COVID-19 is strongly associated with the emergence of ESBL-PE in the context of maximal infection control measures.
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Affiliation(s)
- Guy Lontsi Ngoula
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Stéphanie Houcke
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Séverine Matheus
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Flaubert Nkontcho
- Pharmacy Department, Cayenne General Hospital, 97306 Cayenne, French Guiana
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, 97300 Cayenne, French Guiana
| | - Jean Marc Pujo
- Emergency Department, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Nicolas Higel
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Absettou Ba
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Fabrice Cook
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Cyrille Gourjault
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Roman Mounier
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
- Department of Neuro-ICU, GHU-Paris, Paris University, 75014 Paris, France
| | - Mathieu Nacher
- Clinical Investigation Center, Antilles French Guiana (CIC Inserm 1424), Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Magalie Demar
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, 97300 Cayenne, French Guiana
- Polyvalent Biology Department, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Felix Djossou
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, 97300 Cayenne, French Guiana
- Tropical and Infectious Diseases Department, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Didier Hommel
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, 97300 Cayenne, French Guiana
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9
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Kusuma IY, Pratiwi H, Pitaloka DAE. Role of Pharmacists in Antimicrobial Stewardship During COVID-19 Outbreak: A Scoping Review. J Multidiscip Healthc 2022; 15:2605-2614. [PMID: 36388623 PMCID: PMC9656343 DOI: 10.2147/jmdh.s385170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/25/2022] [Indexed: 08/11/2023] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, pharmacists have been on the front lines of health care, offering vital services. Consequently, the need for pharmacists to support an effective antibiotic stewardship (AMS) program during the COVID-19 outbreak has become increasingly evident. This scoping review was performed to examine related articles in 2020-2022 published in the Scopus, SAGE, and Cochrane databases with the keywords "Pharmacist" and "Antibiotic Stewardship" and "COVID-19". The inclusion criteria were full-text articles written in English. A total of 15 articles were included in this review to describe the role of pharmacists in AMS during the COVID-19 outbreak. In general, pharmacists are responsible for identifying and treating patients during pandemics, ensuring the continued supply and accessibility of medications, promoting health policies, and monitoring antibiotic use for COVID-19 cases and co-infections. At the hospital, as the most significant element for pharmacists on the AMS team, the apparent change is demonstrated in educating patients on telehealth services, clarifying misconceptions about treatments and antibiotic consumption, as well as taking a leadership position to establish local guidelines for the COVID-19 treatment protocol. Pharmacists have an important role in the AMS program, and the COVID-19 pandemic was perceived as a highlight their importance. Therefore, their work with the AMS program needs to be improved as they learn to extend their role in telehealth services, educate and clarify the misconceptions about COVID-19 treatments and other antibiotic consumption in the community, inventory control the COVID-19 drug, antibiotics, and vaccine, as well as take the lead in establishing local guidelines on antibiotic consumption during the pandemic outbreak.
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Affiliation(s)
- Ikhwan Yuda Kusuma
- Institution of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, 6725, Hungary
- Pharmacy Study Program, Faculty of Health, Universitas Harapan Bangsa, Purwokerto, 53182, Indonesia
| | - Hening Pratiwi
- Department of Pharmacy, Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto, 53122, Indonesia
| | - Dian Ayu Eka Pitaloka
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, 45363, Indonesia
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10
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Sasaki Y, Yano M, Umehara A, Tagashira Y. Impact of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial consumption and antimicrobial resistance at a small, local hospital in Japan. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e177. [PMID: 36386012 PMCID: PMC9641504 DOI: 10.1017/ash.2022.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic negatively affected antimicrobial stewardship programs at hospitals throughout Japan by diverting resources toward managing the pandemic. However, antimicrobial stewardship needs to continue regardless of hospital size or supervening crises. Herein, we discuss the impact of COVID-19 on antimicrobial stewardship at a small, local hospital in Japan.
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Affiliation(s)
- Yasuhiro Sasaki
- Department of Infection Control, Tama-Nambu Chiiki Hospital, Tokyo, Japan
| | - Masataka Yano
- Department of Infection Control, Tama-Nambu Chiiki Hospital, Tokyo, Japan
| | - Ayumi Umehara
- Department of Infection Control, Tama-Nambu Chiiki Hospital, Tokyo, Japan
| | - Yasuaki Tagashira
- Department of Infectious Diseases, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
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11
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Zhu B, Zhao X, Li Y, Wang N, Lambert H, Yan F, Jiang Q, Fu C. Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China. Antibiotics (Basel) 2022; 11:1544. [PMID: 36358199 PMCID: PMC9686520 DOI: 10.3390/antibiotics11111544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
There are growing concerns that the coronavirus disease of 2019 (COVID-19) pandemic may change antibiotic use patterns and accelerate antibiotic resistance, but evidence from the community level is lacking. This study aims to estimate the impact of the COVID-19 outbreak on the antibiotic use patterns among a community population in Eastern China. A self-administered medicine diary was used to collect information on antibiotic use from July 2019 to June 2021 among a rural community in Eastern China. We analyzed the changes in antibiotic use patterns over five months from August to December 2019 and the corresponding months in 2020. The risk of antibiotic use and its changes were measured with the incidence rate (IR) and relative risk (RR). In total, 1111 participants were eligible for the final analysis (440 in 2019 and 671 in 2020). After the COVID-19 outbreak, antibiotic use increased by 137% (5.43 per 100 person months in the 2019 vs. 12.89 per 100 person months in the 2020), and after the adjustment of covariates, the adjusted RR was 1.72 (95% CI: 1.10~2.34). It was higher among those who were women (RR = 2.62), aged 35−59 years old (RR = 2.72), non-farmers (RR = 2.75), had less than six years of education (RR = 2.61), had an annual household income over CNY 100,000 (USD 14,940) (RR = 2.60), and had no history of chronic diseases (RR = 2.61) (all p < 0.05). The proportion of cephalosporins consumed increased from 54.29% in 2019 to 64.92% in 2020 (p = 0.011). Among those aged 35 years and older, the proportion of antibiotics obtained from medical facilities increased, while the proportion obtained from retail pharmacies, homes, and other sources decreased (all p < 0.05). The COVID-19 outbreak changed antibiotic use patterns in this study population (Eastern China) significantly. More efforts to monitor and enhance antibiotic stewardship activities at the community level are needed in future.
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Affiliation(s)
- Bingbing Zhu
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xinping Zhao
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yurong Li
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China
| | - Na Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Fei Yan
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China
| | - Qingwu Jiang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China
| | - Chaowei Fu
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China
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12
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Mustafa ZU, Saleem MS, Ikram MN, Salman M, Butt SA, Khan S, Godman B, Seaton RA. Co-infections and antimicrobial use among hospitalized COVID-19 patients in Punjab, Pakistan: findings from a multicenter, point prevalence survey. Pathog Glob Health 2022; 116:421-427. [PMID: 34783630 PMCID: PMC9518253 DOI: 10.1080/20477724.2021.1999716] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There are reports of high rates of antibiotic prescribing among hospitalized patients with COVID-19 around the world. To date, however, there are few reports of prescribing in relation to COVID-19 in Pakistan. Herein, we describe a point prevalence survey of antibiotic prescribing amongst patients hospitalized with suspected or proven COVID-19 in Pakistan. A Point Prevalence Survey (PPS) was undertaken in seven tertiary care health facilities in Punjab Provence, Pakistan. Baseline information about antimicrobial use according to the World Health Organization (WHO) standardized methodology was collected on a single day between 5th and 30 April 2021. A total of 617 patients' records were reviewed and 578 (97.3%) were documented to be receiving an antibiotic on the day of the survey. The majority (84.9%) were COVID-19 PCR positive, 61.1% were male and 34.9% were age 36 to 44 years. One quarter presented with severe disease, and cardiovascular disease was the major comorbidity in 13%. Secondary bacterial infection or co-infection (bacterial infection concurrent with COVID-19) was identified in only 1.4%. On the day of the survey, a mean of 1.7 antibiotics was prescribed per patient and 85.4% antibiotics were recorded as being prescribed for 'prophylaxis'. The most frequently prescribed antibiotics were azithromycin (35.6%), ceftriaxone (32.9%) and meropenem (7.6%). The majority (96.3%) of the antibiotics were empirical and all were from WHO Watch or Reserve categories. Overall, a very high consumption of antibiotics in patients hospitalized with suspected or proven COVID-19 was observed in Pakistan and this is concerning in view of already high rates of antimicrobial resistance in the region. Antimicrobial stewardship programs need to urgently address unnecessary prescribing in the context of COVID-19 infection.
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Affiliation(s)
- Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter Hospital Pakpattan, Pakpattan, Pakistan
| | | | | | - Muhammad Salman
- Department of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Shehroze Khan
- Punjab University College of Pharmacy, University of the Punjab, LahorePakistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - R. Andrew Seaton
- Queen Elizabeth University Hospital, Glasgow, UK
- Healthcare Improvement Scotland, Glasgow, UK
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13
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Comelli A, Genovese C, Lombardi A, Bobbio C, Scudeller L, Restelli U, Muscatello A, Antinori S, Bonfanti P, Casari S, Castagna A, Castelli F, Monforte AD, Franzetti F, Grossi P, Lupi M, Morelli P, Piconi S, Puoti M, Pusterla L, Regazzetti A, Rizzi M, Rusconi S, Zuccaro V, Gori A, Bandera A, Giacomelli A, Rossi M, Bruno R, Garilli S, Marco R, Signorini L, Bai F, Pan A, Merli M, Ricaboni D, Molteni C, Benatti SV, Castiglioni B, Rovelli C, Piazza M, Franzetti M. What is the impact of SARS-CoV-2 pandemic on antimicrobial stewardship programs (ASPs)? The results of a survey among a regional network of infectious disease centres. Antimicrob Resist Infect Control 2022; 11:108. [PMID: 36038903 PMCID: PMC9421115 DOI: 10.1186/s13756-022-01152-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Abstract
Discontinuation of antimicrobial stewardship programs (ASPs) and increased antibiotic use were described during SARS-CoV-2 pandemic. In order to measure COVID-19 impact on ASPs in a setting of high multidrug resistance organisms (MDRO) prevalence, a qualitative survey was designed. In July 2021, eighteen ID Units were asked to answer a questionnaire about their hospital characteristics, ASPs implementation status before the pandemic and impact of SARS-CoV-2 pandemic on ASPs after the 1st and 2nd pandemic waves in Italy. Nine ID centres (50%) reported a reduction of ASPs and in 7 cases (38.9%) these were suspended. After the early pandemic waves, the proportion of centres that restarted their ASPs was higher among the ID centres where antimicrobial stewardship was formally identified as a priority objective (9/11, 82%, vs 2/7, 28%). SARS-CoV-2 pandemic had a severe impact in ASPs in a region highly affected by COVID-19 and antimicrobial resistance but weaknesses related to the pre-existent ASPs might have played a role.
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14
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Elligsen M, Wan M, Lam PW, Lo J, Taggart LR, Chan AJ, Downing M, Gough K, Seah J, Leung E. Trends in hospital antibiotic utilization during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter interrupted time-series analysis. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e128. [PMID: 36483375 PMCID: PMC9726493 DOI: 10.1017/ash.2022.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 06/17/2023]
Abstract
Objective To describe the evolution of respiratory antibiotic prescribing during the coronavirus disease 2019 (COVID-19) pandemic across 3 large hospitals that maintained antimicrobial stewardship services throughout the pandemic. Design Retrospective interrupted time-series analysis. Setting A multicenter study was conducted including medical and intensive care units (ICUs) from 3 hospitals within a Canadian epicenter for COVID-19. Methods Interrupted time-series analysis was used to analyze rates of respiratory antibiotic utilization measured in days of therapy per 1,000 patient days (DOT/1,000 PD) in medical units and ICUs. Each of the first 3 waves of the pandemic were compared to the baseline. Results Within the medical units, use of respiratory antibiotics increased during the first wave of the pandemic (rate ratio [RR], 1.76; 95% CI, 1.38-2.25) but returned to the baseline in waves 2 and 3 despite more COVID-19 admissions. In ICU, the use of respiratory antibiotics increased in wave 1 (RR, 1.30; 95% CI, 1.16-1.46) and wave 2 of the pandemic (RR, 1.21; 95% CI, 1.11-1.33) and returned to the baseline in the third wave, which had the most COVID-19 admissions. Conclusions After an initial surge in respiratory antibiotic prescribing, we observed the normalization of prescribing trends at 3 large hospitals throughout the COVID-19 pandemic. This trend may have been due to the timely generation of new research and guidelines developed with frontline clinicians, allowing for the active application of new research to clinical practice.
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Affiliation(s)
- Marion Elligsen
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michael Wan
- Department of Pharmacy, St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Philip W. Lam
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Lo
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda R. Taggart
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - April J. Chan
- Department of Pharmacy, St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mark Downing
- Division of Infectious Diseases, St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kevin Gough
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jenny Seah
- Department of Pharmacy, St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Elizabeth Leung
- Department of Pharmacy, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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15
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Yang Y, Geng X, Liu X, Wen X, Wu R, Cui D, Mao Z. Antibiotic Use in China’s Public Healthcare Institutions During the COVID-19 Pandemic: An Analysis of Nationwide Procurement Data, 2018–2020. Front Pharmacol 2022; 13:813213. [PMID: 35237164 PMCID: PMC8882946 DOI: 10.3389/fphar.2022.813213] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The overuse of antibiotics is a serious public health problem and a major challenge in China, and China lacks up-to-date evidence on the nationwide antibiotic use in different healthcare settings. The changes of China’s antibiotic use under the COVID-19 pandemic are still unknown. Objective: This study aimed to investigate the use of antibiotics in China’s public medical institutions based on a three-year nationwide surveillance and to examine the impact of the COVID-19 pandemic on China’s antibiotic consumption. Methods: This study used nationwide drug procurement data from the China Drug Supply Information Platform (CDSIP). We retrospectively analyzed antibiotic procurement data of 9,176 hospitals and 39,029 primary healthcare centers (PHCs) from 31 provinces in mainland China from January 2018 to December 2020. Antibiotic utilization was measured by defined daily doses (DDDs) and DDD per 1,000 inhabitants per day (DID). Generalized linear regression models were established to quantify the impact of the COVID-19 pandemic on antibiotic use. Results: The total antibiotic consumption among all healthcare settings increased from 12.94 DID in 2018 to 14.45 DID in 2019, and then dropped to 10.51 DID in 2020. More than half of antibiotics were consumed in PHCs, especially in central regions (59%–68%). The use of penicillins (J01C) and cephalosporins (J01D) accounted for 32.02% and 28.86% of total antibiotic consumption in 2020. During 2018–2020, parenteral antibiotics accounted for 31%–36% of total antibiotic consumption; the proportion is more prominent in central and western regions and the setting of hospitals. Access category antibiotics comprised 40%–42% of the total utilization. Affected by COVID-19, the antibiotic consumption was significantly dropped both in hospitals (β = −.11, p < .001) and PHCs (β = −.17, p < .001), as well as in total (β = −.14, p < .001). Significant increments were observed in the proportion of total antibiotics (β = .02, p = .024) consumed in hospitals (against the consumption in all healthcare settings), as well as parenteral antibiotics (β = 1.73, p = .001). Conclusion: The consistent preferred use of penicillin and cephalosporin, as well as injections, among China’s public healthcare institutions should draw concern. China’s antibiotic consumption significantly declined during the COVID-19 pandemic, which brings opportunities for antibiotic use management in China.
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Affiliation(s)
- Ying Yang
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Xin Geng
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Xiaojun Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaotong Wen
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Ruonan Wu
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Dan Cui
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Zongfu Mao
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
- Dong Fureng Economic and Social Development School, Wuhan University, Wuhan, China
- *Correspondence: Zongfu Mao,
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16
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Zakharenkov IA, Rachina SA, Kozlov RS, Belkova Y. Consumption of systemic antibiotics in the Russian Federation in 2017–2021. CLINICAL MICROBIOLOGY AND ANTIMICROBIAL CHEMOTHERAPY 2022. [DOI: 10.36488/cmac.2022.3.220-225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective.
To assess level and the structure of systemic antibiotic consumption in Russia over the period 2017 to 2021.
Materials and Methods.
Data were collected and analysed in compliance with the standard protocol of the World Health Organization Regional Office for Europe by the means of ATC/DDD methodology for J01 group – antibacterials for systemic use. Consumption was calculated for outpatients and inpatients separately as a number of DDDs per 1000 inhabitants per day (DID) for the main classes of antibiotics and the agents with the highest or the most diverse consumption levels for the given period of time, and was based on the data of wholesale purchases and public tenders.
Results.
Antibiotic consumption in Russia in 2017, 2018, 2019, 2020, and 2021 was 16.6 DID, 14.3 DID, 14.8 DID, 19 DID, and 15.7 DID respectively. Penicillins, macrolides and lincosamides, and quinolones had the highest levels of consumption in outpatients. Prominent increase in outpatient consumption of antibacterials in 2020 was related to three agents: azithromycin, levofloxacin and ceftriaxone. Cephalosporins (mainly III–V generations), quinolones and penicillins had the highest levels of consumption in inpatients. Hospital consumption of meropenem, tigecycline, and vancomycin increased and amikacin and ciprofloxacin decreased over the duration of the study.
Conclusions.
Levels of systemic antibiotic consumption in Russia for the period 2017 to 2019 were relatively low and consistent with the average means for European Union and European Economic Area countries. The steep increase in consumption in 2020 was probably due to the wide use of antibiotics for the management of COVID-19 patients. The results of the study can be of value for the development of targeted national antibiotic stewardship programs and awareness campaigns as well as for the analysis of trends of emergence and spread of antibiotic resistance.
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Affiliation(s)
| | | | | | - Yu.A. Belkova
- Smolensk State Medical University (Smolensk, Russia)
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17
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Silva ARO, Salgado DR, Lopes LPN, Castanheira D, Emmerick ICM, Lima EC. Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital. Front Pharmacol 2021; 12:778386. [PMID: 34955847 PMCID: PMC8703131 DOI: 10.3389/fphar.2021.778386] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Microbial drug resistance is one of the biggest public health problems. Antibiotic consumption is an essential factor for the emergence and spread of multiresistant bacteria. Therefore, we aimed to analyze the antibiotics consumption in the Intensive Care Unit (ICU), identifying trends in the antibiotics use profile and microbiological isolates throughout the COVID-19 pandemic. Methods: We performed this retrospective observational study in intensive care units of a Brazilian tertiary hospital from January 2019 to December 2020. The primary outcome was antimicrobial consumption in the ICU, measured by defined daily doses (DDDs) per 100 bed-days. As a secondary outcome, bacterial infections (microbiological isolates) were calculated in the same fashion. Outcomes trends were analyzed using Joinpoint regression models, considering constant variance (homoscedasticity) and first-order autocorrelation assumptions. A monthly percent change (MPC) was estimated for each analyzed segment. Results: Seven thousand and nine hundred fifty-three patients had data available on prescribed and received medications and were included in the analyses. Overall, the use of antibiotics increased over time in the ICU. The reserve group (World Health Organization Classification) had an increasing trend (MPC = 7.24) from February to April 2020. The azithromycin consumption (J01FA) increased rapidly, with a MPC of 5.21 from January to April 2020. Polymyxin B showed a relevant increase from March to June 2020 (MPC = 6.93). The peak of the antibiotic consumption of Reserve group did not overlap with the peak of the pathogenic agents they are intended to treat. Conclusion: Overall antimicrobial consumption in ICU has increased in the context of the COVID-19 pandemic. The peaks in the antimicrobial's use were not associated with the rise of the pathogenic agents they intended to treat, indicating an empirical use, which is especially concerning in the context of treating multidrug-resistant (MDR) infections. This fact may contribute to the depletion of the therapeutic arsenal for MDR treatment.
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Affiliation(s)
| | - Diamantino Ribeiro Salgado
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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18
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Khan S, Hasan SS, Bond SE, Conway BR, Aldeyab MA. Antimicrobial consumption in patients with COVID-19: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2021; 20:749-772. [PMID: 34895002 DOI: 10.1080/14787210.2022.2011719] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Since the onset of the pandemic, prescribing antimicrobials has become a common practice to treat patients infected with COVID-19. AREAS COVERED A systematic literature search was performed in the electronic databases MEDLINE, CINAHL, WHO COVID-19 database, including EMBASE, Scopus, WHO-COVID, LILACS, and Google Scholar to identify original articles published up to 31 July 2021. A random-effects model was used to estimate the pooled prevalence or proportion of antimicrobial consumption among COVID-19 patients. EXPERT OPINION We identified 43 original articles, 33 studies from high-income countries, six from upper-middle-income countries, and four from lower-middle-income countries. Most of the studies presented data from hospital or secondary health-care settings (n = 34). Included studies measured antimicrobial consumption as Daily Defined Doses (DDD) or day of therapy (DOT) or percentage. A total of 19 studies measured antimicrobial consumption as DDDs or DOT. Meta-analysis revealed an overall high antimicrobial consumption of 68% (95% CI: 60% to 75%). The subgroup analysis found a lower consumption in high-income countries (58%, 95% CI: 48% to 67%), compared with lower and middle-income countries (89%, 95% CI: 82% to 94%). High antimicrobial consumption found in COVID-19 patients demands implementation of appropriate antimicrobial stewardship interventions.
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Affiliation(s)
- Sidra Khan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Syed Shahzad Hasan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Stuart E Bond
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Barbara R Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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19
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Rusic D, Vilovic M, Bukic J, Leskur D, Seselja Perisin A, Kumric M, Martinovic D, Petric A, Modun D, Bozic J. Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks. Life (Basel) 2021; 11:life11030220. [PMID: 33801799 PMCID: PMC8000815 DOI: 10.3390/life11030220] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 12/23/2022] Open
Abstract
The net effect of the coronavirus disease 2019 (COVID-19) pandemic and the response to it on the emergence of antimicrobial resistance is yet unknown. Positive impacts on the spread of multiresistant pathogens and infections in general may be observed with the implementation of general preventative measures for the spread of infectious disease such as social distancing, reduced travel and increased personal hygiene. This pandemic has accelerated the development of novel technologies, such as mRNA vaccines, that may be used to fight other diseases. These should be capitalized upon to manage the ongoing antimicrobial resistance pandemic in the background. However, it is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rates of inappropriate antimicrobial prescribing, the high use of biocides and the interruption of treatment for other conditions. Clinical uncertainty driven by the lack of effective diagnostics and practice of telemedicine may have driven the inappropriate use of antimicrobials. As pathogens know no borders, increased focus is needed for infectious diseases still threatening low- and middle-income countries such as tuberculosis. Stewardship measures for future outbreaks should stress the importance of social distancing and hand washing but discourage the overuse of disinfectants and antimicrobials that are not proven effective.
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Affiliation(s)
- Doris Rusic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Ana Seselja Perisin
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Dinko Martinovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Ana Petric
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
- Split-Dalmatia County Pharmacy, Kneza Ljudevita Posavskog 12 b, 21 000 Split, Croatia
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
- Correspondence:
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