Abstract
During the recent pandemic, the fact that the clinical manifestation of COVID-19 may be indistinguishable from bacterial infection, as well as concerns of bacterial co-infection, have been associated with an increased use of antibiotics. The objective of this study was to assess the effect of targeted antibiotic stewardship programs (ASP) on the use of antibiotics in designated COVID-19 departments and to compare it to the antibiotic use in the equivalent departments in the same periods of 2018 and 2019. Antibiotic consumption was assessed as days of treatment (DOT) per 1000 patient days (PDs). The COVID-19 pandemic was divided into three periods (waves) according to the pandemic dynamics. The proportion of patients who received at least one antibiotic was significantly lower in COVID-19 departments compared to equivalent departments in 2018 and 2019 (Wave 2: 30.2% vs. 45.6% and 44.9%, respectively; Wave 3: 30.5% vs. 47.8% and 50.1%, respectively, p < 0.001). The DOT/1000PDs in every COVID-19 wave was lower than during similar periods in 2018 and 2019 (179-282 DOT/1000PDs vs. 452-470 DOT/1000PDs vs. 426-479 DOT/1000PDs, respectively). Moreover, antibiotic consumption decreased over time during the pandemic. In conclusion, a strong ASP is effective in restricting antibiotic consumption, particularly for COVID-19 which is a viral disease that may mimic bacterial sepsis but has a low rate of concurrent bacterial infection.
Highlights
SARS-CoV-2 emerged in December 2019 and has since imposed an enormous burden on healthcare systems worldwide
This study looked to compare the antibiotic consumption in those designated COVID-19 departments to the antibiotic consumption in those same departments at the equivalent calendar months of 2018 and 2019, before the COVID-19 pandemic
In this retrospective study at a large tertiary hospital, the overall antibiotic consumption was lower among patients who were hospitalized in COVID-19 departments than that observed in the equivalent non-COVID-19 departments who were treated by the same medical teams during the same calendar months of 2018 and 2019
Summary
SARS-CoV-2 emerged in December 2019 and has since imposed an enormous burden on healthcare systems worldwide. The clinical manifestations of severe COVID-19 may be indistinguishable from those of bacterial infection, characterized by acute onset, fever, increased inflammatory markers, and organ failure [1]. This clinical uncertainty as well as the lack of effective treatment options for SARS-CoV-2 were among the reasons for the widespread use of antibiotics early in the pandemic [2]. Detailed review of patient data shows that only around 6% of hospitalized COVID-19 patients have microbiologically confirmed bacterial co-infection [5,6] This is in contrast to influenza, where bacterial co-infection was reported in around 30% of hospitalized patients [7]. A recent meta-analysis of seven randomized clinical trials that evaluated the impact of azithromycin on clinical outcomes of COVID-19 patients has shown no favorable effect on mortality or length of stay [8]
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