Abstract
Background: The first wave of COVID-19 pandemic may have significantly impacted antimicrobial consumption in hospitals. The objective of this study was to assess the evolution of antimicrobial consumption during this period. Methods: A retrospective quasi-experimental before–after study was conducted in a Spanish tertiary care hospital. The study compared two periods: pre-pandemic, from January 2018 to February 2020, and during the COVID-19 pandemic from March to June 2020. Antimicrobial consumption was analyzed monthly as defined daily doses (DDD)/100 bed-days and overall hospital and ICU consumption were evaluated. Results: An increase in the hospital consumption was noticed. Although only ceftaroline achieved statistical significance (p = 0.014), a rise was observed in most of the studied antimicrobials. A clear temporal pattern was detected. While an increase in ceftriaxone and azithromycin was observed during March, an increment in the consumption of daptomycin, carbapenems, linezolid, ceftaroline, novel cephalosporin/β-lactamase inhibitors or triazoles during April–May was noticed. In the ICU, these findings were more evident, namely ceftriaxone (p = 0.029), carbapenems (p = 0.002), daptomycin (p = 0.002), azithromycin (p = 0.030), and linezolid (p = 0.011) but followed a similar temporal pattern. Conclusion: An increase in the antimicrobial consumption during the first wave of COVID-19 pandemic was noticed, especially in the ICU. Availability of updated protocols and antimicrobial stewardship programs are essential to optimize these outcomes.
Highlights
Introduction conditions of the Creative CommonsDue to the concerns about the increase in antimicrobial resistance, a series of initiatives have been proposed to try to alleviate this problem
Potential causes include an increase in hospital stay associated with this infection or the high rate of intensive care unit (ICU) admission, which led to the collapse of beds for the care of critical patients
The crest of the wave happened on 1 April 2020, when 386 patients diagnosed with COVID-19 were hospitalized
Summary
Introduction conditions of the Creative CommonsDue to the concerns about the increase in antimicrobial resistance, a series of initiatives have been proposed to try to alleviate this problem. One of the strategies of the ASPs is to carry out an exhaustive monitoring of antimicrobial consumption [5] For this purpose, among the different measures, defined daily doses (DDD)/100 bed-days stand out as the most common source of information [5]. One of the main reasons would be the potential overprescription of antimicrobials due to concerns about bacterial co-infection. This trend is derived from influenza, an infection in which a high prevalence (58%) of co-infection has been demonstrated [7], mainly due to Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes [8]. There were differences in incidence, and in the bacterial co-pathogen profiles, as in patients diagnosed with COVID-19, the commonest bacteria were Mycoplasma pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae [9]
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