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Patel TS, McGovern OL, Mahon GW, Boszczowski I, Munita JM, Garzon MI, Lipari F, Salomao M, Marssola G, Tavares B, Francisco D, Gurgel APA, Arantes T, Bori A, Nogueira C, Peters A, Spencer M, Orellana C, Barbe M, Roldán A, Lopez C, Bortoletto J, Stender SC, Lessa FC. 1573. Impact of the COVID-19 Pandemic on Antibiotic Use among Hospitalized Adults in Argentina, Brazil, and Chile. Open Forum Infect Dis 2022. [PMCID: PMC9752275 DOI: 10.1093/ofid/ofac492.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Reports showing high rates of antibiotic use (AU) in patients with coronavirus disease 2019 (COVID-19) despite low rates of secondary bacterial infection have emerged from various countries across the globe. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in Argentina, Brazil, and Chile. Methods We conducted an ecologic evaluation of AU in inpatient adult acute care wards (excluding maternity wards) in 6 HCFs in Argentina, Brazil, and Chile; 2 HCFs per country. AU data for intravenously administered antibiotics commonly used to treat respiratory infections were collected from pharmacy dispensing records and aggregated to monthly defined daily dose (DDD)/1000 patient days. Graphs were created to depict AU and COVID-19 discharges over time throughout the 36-month study period (03/2018–02/2021). Relative changes in AU for all antibiotics combined and specific classes were calculated by comparing median AU for the 24-month pre-pandemic period (3/2018–2/2020) with the 12-month pandemic period (3/2020–2/2021). Only statistically significant differences (P< 0.05) determined by the Wilcoxon signed-rank test are reported. Results Compared to the pre-pandemic period, the use of all included antibiotics combined increased in 4/6 HCFs (6.7–35.1%). In the 4 HCFs that experienced increases in AU, Figure 1 shows that use was high during months when COVID-19 patient surges occurred. In 3/4 of these HCFs, AU remained high despite significant decreases in COVID-19 discharges. Ceftriaxone use increased in 2/6 HCFs (27.1–51.6%). Use of β-lactam antibiotics with activity against Pseudomonas aeruginosa increased in 3/6 HCFs (31.3–82.5%) and decreased in 1/6 HCFs (-18.9%). Vancomycin and linezolid use increased in 3/6 HCFs (36.9–77.1%). Conclusion Increases in AU among hospitalized adults were observed in 4 of 6 South American HCFs included in this study. The high rates of broad-spectrum antibiotic use in the HCFs may impact further emergence of antibiotic resistance. Understanding how this increase in antibiotic use compares to rates of bacterial infections during this time period is critical. Disclosures Jose M. Munita, MD, BioMerieux: Grant/Research Support|MSD: Grant/Research Support|Pfizer: Grant/Research Support Matias Salomao, MD, Cepheid: Lecture.
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Affiliation(s)
- Twisha S Patel
- Chenega Enterprise Systems and Solutions (CHESS) / Centers for Disease Control and Prevention, Ann Arbor, MI
| | | | - Garrett W Mahon
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jose M Munita
- Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Region Metropolitana, Chile
| | - Maria I Garzon
- Hospital Privado Universitario de Córdoba, Cordoba, Cordoba, Argentina
| | - Flavio Lipari
- Hospital Dr. Angel Ferreyra, Cordoba, Cordoba, Argentina
| | - Matias Salomao
- Hospital das Clinicas da Universidade de São Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | - Bruno Tavares
- Hospital das Clínicas Faculdade de Medicina da USP and Hospital Alemão Oswaldo Cruz, São Paulo, Sao Paulo, Brazil
| | - Debora Francisco
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, São Paulo, Sao Paulo, Brazil
| | | | - Tiago Arantes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Sao Paulo, Brazil
| | - Andrea Bori
- Instituto do Coração HCFMUSP, São Paulo, Sao Paulo, Brazil
| | | | - Anne Peters
- Instituto de Ciencias e Innovación en Medicina, Santiago, Region Metropolitana, Chile
| | - Maria Spencer
- Instituto de Ciencias e Innovación en Medicina, Santiago, Region Metropolitana, Chile
| | - Cristian Orellana
- Hospital Padre Hurtado, Santiago, Chile, Santiago, Region Metropolitana, Chile
| | - Mario Barbe
- Clínica Alemana, Universidad del Desarrollo, Santiago, Region Metropolitana, Chile
| | - Analía Roldán
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina, Cordoba, Cordoba, Argentina
| | - Constanza Lopez
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina, Cordoba, Cordoba, Argentina
| | - Josefina Bortoletto
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina, Cordoba, Cordoba, Argentina
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Osuka H, Patel TS, McGovern OL, Boszczowski I, Munita JM, Garzon MI, Lipari F, Salomao M, Marssola G, Travares B, Peters A, Spencer M, Porte L, Barbe M, Rojas P, Stender SC, Lessa FC. 1917. Impact of the COVID-19 Pandemic on Antimicrobial Stewardship, Infection Prevention & Control, and Clinical Microbiology Practices in Argentina, Brazil, and Chile. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities (HCFs) were overwhelmed with increasing patient volumes and limited resources. Reports of disruptions in routine practices at HCFs have emerged. We evaluated changes in policies, practices, and programs for antimicrobial stewardship (AMS), infection prevention and control (IPC), and clinical microbiology across six HCF in South America following the onset of the COVID-19 pandemic.
Methods
We conducted a survey in 6 HCFs in Argentina, Brazil, and Chile; 2 HCFs in each country. Data on 5 components (facility characteristics, antibiotic procurement and distribution, AMS activities, IPC activities, and clinical microbiology) were collected from designated specialists within each HCF from March 2018 – February 2021. We compared observations within these 5 components pre-pandemic (March 2018 – February 2020) to during pandemic (March 2020 – February 2021.)
Results
During the pandemic, the number of ICU beds increased across all the 6 HCFs by 57-633%, and the number of ventilators increased by 15-317% in 5 out of the 6 HCFs. Healthcare personnel shortages were observed in all 6 HCFs, notably common for nurses and laboratory personnel (Table 1). Extended use of N95 respirators was reported across all 6 HCFs with 2 doing extended use of gowns and medical masks. The only PPE reused was N95 respirators in 2 HCFs. Difficulties in cohorting patients with multi-drug resistance organism (MDRO) was reported by one of the HCFs. Three HCFs reported shortages in drugs with coverage for MRSA, gram-negative bacteria, and fungal pathogens despite no reports of interruption in AMS activities in these HCFs. Two hospitals reported delays on microbiology results.
Facility characteristics and reported changes during COVID-19 pandemic (March 2020-February 2021)
Conclusion
The COVID-19 pandemic led to substantial increases in ICU beds, number of ventilators, and extended use of PPE suggesting increases in admission of severe patients and suboptimal IPC practices in HCFs in South America. It is unclear if shortages in agents commonly used to treat MDRO was related to overuse or access difficulties. Additional evaluation is needed to determine the impact of these findings on antimicrobial resistance and antimicrobial use.
Disclosures
Matias Salomao, MD, Cepheid: Lecture.
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Affiliation(s)
| | - Twisha S Patel
- Chenega Enterprise Systems and Solutions (CHESS) / Centers for Disease Control and Prevention , Ann Arbor, MI
| | | | | | - Jose M Munita
- Instituto de Ciencias e Innovación en Medicina , Santiago, Region Metropolitana , Chile
| | - Maria I Garzon
- Hospital Privado Universitario de Córdoba , Cordoba, Cordoba , Argentina
| | - Flavio Lipari
- Hospital Dr. Angel Ferreyra , Cordoba, Cordoba , Argentina
| | - Matias Salomao
- Hospital das Clinicas da Universidade de São Paulo , Sao Paulo, Sao Paulo , Brazil
| | | | - Bruno Travares
- Hospital das Clinicas da Universidade de São Paulo , Sao Paulo, Sao Paulo , Brazil
| | - Anne Peters
- Instituto de Ciencias e Innovación en Medicina , Santiago, Region Metropolitana , Chile
| | - Maria Spencer
- Instituto de Ciencias e Innovación en Medicina , Santiago, Region Metropolitana , Chile
| | - Lorena Porte
- Clínica Alemana, Universidad del Desarrollo , Santiago, Region Metropolitana , Chile
| | - Mario Barbe
- Clínica Alemana, Universidad del Desarrollo , Santiago, Region Metropolitana , Chile
| | - Pamele Rojas
- Hospital Padre Hurtado , Santiago, Region Metropolitana , Chile
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