Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections.

Ana Belén Guisado-Gil ,Manuel Poyato Borrego ,María Dolores Navarro-Amuedo ,Sonsoles Salto‐Alejandre ,María Victoria Gil-Navarro ,Maite Ruíz-Pérez De Pipaón ,Carmen Infante-Domínguez ,Manuela Aguilar‐Guisado ,Jerónimo Pachón ,Germán Peñalva ,Teresa Aldabó ,José Antonio Lepe ,Nieves Romero-Rodríguez ,Julia Praena ,José Antonio Molina ,Cristina Roca ,Guillermo Martín-Gutiérrez ,Nuria Espinosa-Aguilera ,José Miguel Cisneros

doi:10.3390/antibiotics9110816

Abstract

During the COVID-19 pandemic, the implementation of antimicrobial stewardship strategies has been recommended. This study aimed to assess the impact of the COVID-19 pandemic in a tertiary care Spanish hospital with an active ongoing antimicrobial stewardship programme (ASP). For a 20-week period, we weekly assessed antimicrobial consumption, incidence density, and crude death rate per 1000 occupied bed days of candidemia and multidrug-resistant (MDR) bacterial bloodstream infections (BSI). We conducted a segmented regression analysis of time series. Antimicrobial consumption increased +3.5% per week (p = 0.016) for six weeks after the national lockdown, followed by a sustained weekly reduction of −6.4% (p = 0.001). The global trend for the whole period was stable. The frequency of empirical treatment of patients with COVID-19 was 33.7%. No change in the global trend of incidence of hospital-acquired candidemia and MDR bacterial BSI was observed (+0.5% weekly; p = 0.816), nor differences in 14 and 30-day crude death rates (p = 0.653 and p = 0.732, respectively). Our work provides quantitative data about the pandemic effect on antimicrobial consumption and clinical outcomes in a centre with an active ongoing institutional and education-based ASP. However, assessing the long-term impact of the COVID-19 pandemic on antimicrobial resistance is required.

Highlights

Since the declaration on 31 December 2019 of a cluster of cases of pneumonia in Wuhan caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus, more than 50 million cases have been diagnosed worldwide with a mortality rate of 2.5% [1]
Analysing the results over the course of the COVID-19 pandemic, the antimicrobial consumption showed an increase of +3.5% per week (p = 0.016) from the beginning until week
The results of our study demonstrate the effect of the COVID-19 pandemic on antimicrobial consumption and the incidence and death rates of hospital-acquired candidemia and MDR bacterial

Summary

Introduction

Since the declaration on 31 December 2019 of a cluster of cases of pneumonia in Wuhan caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus, more than 50 million cases have been diagnosed worldwide with a mortality rate of 2.5% [1]. (COVID-19) with a rapidly increasing number of cases [2]. This fact led the Spanish government to declare a national lockdown on 14 March. For the COVID-19 pandemic, major adjustments of both the healthcare system and frameworks have been required to limit the spread of the virus and avoid unintended collateral effects such as inappropriate antimicrobial prescription and its consequences on antimicrobial resistance [3,4,5,6,7]. Recent studies have reported an unjustified increase of antimicrobial use during the COVID-19 pandemic [8], despite recommendations against it unless bacterial or fungal coinfections were demonstrated [9,10]. The impact of the overuse of these therapies on the propagation of antimicrobial resistance could be an indirect adverse consequence of the pandemic [11,12,13]

Objectives

Results

Discussion

Conclusion