Effects of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial prevalence and prescribing in a tertiary hospital in Singapore

Tat Ming Ng,David C Lye,Hui Lin Tay,Min Yi Yap,Tau Hong Lee,Shi Thong Heng,Christine B Teng,Boon Hou Chua,Sock Hoon Tan

doi:10.1186/s13756-021-00898-8

Abstract

BackgroundThe deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing.MethodsOne of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017–2019.ResultsThe prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08).ConclusionDuring the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.

Highlights

The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance
During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators
In terms of antimicrobial utilization, there was a significant reduction of 361.46 defined dose (DDD)/1000 patient days/month (p < 0.01) before and after the peak of the COVID-19 pandemic in Singapore in April 2020 [9]

Summary

Introduction

The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. The global response to the coronavirus disease 2019 (COVID-19) pandemic has focused on controlling the spread of infection and development of treatment and vaccines [1]. (SARS-CoV-2) infection are fever, sore throat, fatigue, cough or dyspnea [2]. These symptoms may prompt clinicians to start antibiotics to treat community-acquired pneumonia or COVID-19 with secondary bacterial infection. Among COVID-19 patients, 1450 of 2010 (72%) received antibiotics. These agents tended to be broad-spectrum and empiric [3].

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