The Impact of the SARS-Cov2 Pandemic on a Persuasive Educational Antimicrobial Stewardship Program in a University Hospital in Southern Italy: A Pre-Post Study.

Margherita Macera,Giovanna Donnarumma,Lorenzo Onorato,Giuseppe Signoriello,Rosa Annibale,Massimiliano Galdiero,Maria Vittoria Montemurro,Nicola Coppola,Federica Calò,Caterina Monari

doi:10.3390/antibiotics10111405

Margherita Macera, Giovanna Donnarumma + Show 8 more

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https://doi.org/10.3390/antibiotics10111405

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Abstract

Objectives: We evaluated the effect of the pandemic on the disruption of a persuasive educational antimicrobial stewardship program (ASP) conducted in a university hospital in southern Italy. Methods: In March 2020, the ASP, which began in January 2017 and was carried out at different times in 10 wards, was stopped due to the COVID-19 pandemic. We conducted an observational study with interrupted time series analysis to compare the antibiotic consumption and costs, average length of hospital stay and in-hospital mortality between 12 months before and 9 months after the interruption. Results: Four medical, four surgical wards and two ICUs were included in the study, for a total of 35,921 patient days. Among the medical wards we observed after the interruption a significant increase in fluoroquinolone use, with a change in trend (CT) of 0.996, p = 0.027. In the surgical wards, we observed a significant increase in the overall consumption, with a change in level (CL) of 24.4, p = 0.005, and in the use of third and fourth generation cephalosporins (CL 4.7, p = 0.003). In two ICUs, we observed a significant increase in piperacillin/tazobactam and fluoroquinolone consumption (CT 9.28, p = 0.019, and 2.4, p = 0.047). In the wards with a duration of ASP less than 30 months, we observed a significant increase in antibiotic consumption in the use of piperacillin/tazobactam and fluoroquinolones (CT 12.9, p = 0.022: 4.12, p = 0.029; 1.004, p = 0.011). Conclusions: The interruption of ASP during COVID-19 led to an increase in the consumption of broad-spectrum antibiotics, particularly in surgical wards and in those with a duration of ASP less than 30 months.

Highlights

Antibiotic resistance is a major public health problem and antimicrobial overuse is considered the principal driver in selecting antimicrobial-resistant organisms [1]
With regards the medical wards (Table 1), we did not observe a significant difference in the overall antibiotic consumption between the two study periods, with a change in level (CL) from −3.1 defined daily dose (DDD)/100 patient days (PD), 95% CI −67.3 to 61.1, p = 0.92, and a change in trend (CT) from 15.4, CI −3.7 to 34.9, p = 0.11
No significant change was registered for carbapenem use (CL 3.2, 95% CI −8.9 to 15.4, p = 0.58), as well as for the consumption of piperacillin/tazobactam (CL −1.5, 95% CI −9.8 to 6.8, p = 0.7) and third and fourth generation cephalosporins (CL −3.7, 95% CI −13.9 to 6.5, p = 0.45)

Summary

Introduction

Antibiotic resistance is a major public health problem and antimicrobial overuse is considered the principal driver in selecting antimicrobial-resistant organisms [1]. To counter this phenomenon, antimicrobial stewardship programs (ASPs) have been launched in many hospitals. Since December 2019, a new beta-corona virus (SARS-CoV-2) has spread all over the world from Wuhan in China [2], causing a disease known as Coronavirus disease (COVID-19). Due to the SARS-CoV-2 pandemic, some of the ASPs were interrupted to reorganize the work activity in the hospital sector. There are few data on the consumption of antimicrobials during the COVID-19 pandemic, as well as in settings where ASPs were active

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