Interrupted Time Series Analysis of Pediatric Infectious Diseases and the Consumption of Antibiotics in an Atlantic European Region during the SARS-CoV-2 Pandemic.

Ana Clavería,María Victoria Delgado-Martín,Rita Villarino-Moure,Javier Roca,Clara García-Cendón,Carolina Barreiro-Arceiz,María Victoria Martín-Miguel,Isabel Rey-Gómez-Serranillos,José Manuel Iglesias-Moreno,Ana Goicoechea-Castaño

doi:10.3390/antibiotics11020264

Abstract

The increasing concern about bacterial resistance has made the rational prescription of antibiotics even more urgent. The non-pharmacological measures established to reduce the impact of the SARS-CoV-2 pandemic have modified the epidemiology of pediatric infections and, consequently, the use of antibiotics. Interrupted time series (ITS) analyses are quasi-experimental studies that allow for the estimation of causal effects with observational data in “natural experiments”, such as changes in health policies or pandemics. The effect of the SARS-CoV-2 pandemic on the incidence of infectious diseases and the use of antibiotics between 2018 and 2020 in the Health Area of Vigo (Galicia, Spain) was quantified and analyzed. This paper outlines a real-world data study with administrative records from primary care services provided for the pediatric population. The records were related to episodes classified as infectious by the International Classification of Primary Care (ICPC-2) and oral medication in the therapeutic subgroup J01, corresponding to antibiotics for systemic use, according to the World Health Organization’s Anatomical Therapeutic Chemical (ATC) classification system. The records were classified according to incident episodes, age, dose per inhabitant, and year. Segmented regression models were applied using an algorithm that automatically identifies the number and position of the change points. During the SARS-CoV-2 pandemic, the number of infectious diseases being transmitted between individuals, through the air and through the fecal–oral route, significantly decreased, and a slight decrease in infections transmitted via other mechanisms (urinary tract infections) was also found. In parallel, during the months of the pandemic, there has been a marked and significant reduction in antibacterial agent utilization, mainly of penicillins, cephalosporins, and macrolides.

Highlights

Since their discovery by Fleming [1] until the present day, the use of antibiotics has undergone considerable changes
The segmented regression methods revealed a significant effect of the SARS-CoV-2 pandemic on the infectious episodes registered in the primary care clinical histories of a pediatric population
The region of Vigo (Galicia, Spain) was considered. It has a population of 569,534 inhabitants who are part of 43 basic health areas, with a healthcare center in each of these areas that has an average of 14,000 inhabitants per healthcare center, while the pediatric population comprises 13% of the total population

Summary

Introduction

Since their discovery by Fleming [1] until the present day, the use of antibiotics has undergone considerable changes. Against Resistance to Antibiotics (PRAN) [7]. According to data from 2020, bacterial isolate resistance in Spain was 4.7% [8], higher than that of countries such as Sweden, France, or Germany, with rates of 0.3%, 0.5%, and 0.5%, respectively. Other countries such as Greece or Bulgaria were found to have the highest rates, at 66% and 28.1%, respectively. An increased awareness regarding the rational use of antibiotics has been promoted by healthcare workers, we are far from achieving global awareness of this issue

Methods

Results

Conclusion