Antibiotic prescription during the COVID-19 pandemic: A biphasic pattern

Abstract

To the Editor-The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a public health problem of historic dimensions. However, this pandemic is occurring in the setting of an antimicrobial resistance crisis that is increasing at an alarming pace worldwide. Of concern, countries with a particularly high incidence of COVID-19 also have significant rates of infection caused by multidrug-resistant bacteria. During the 2009 influenza pandemic, coinfection with bacteria was identified as a prognostic factor for the worse outcomes. 1 This finding has led to empirical antibiotic therapy being recommended for patients with suspected influenza pneumonia, 2 and it has probably been a major reason underpinning the initial World Health Organization's recommendation to use empirical antibiotics in cases of COVID-19 pneumonia. 3 Although this guideline advocated for early antimicrobial de-escalation, a couple of factors may have hindered this practice. First, processing microbiological samples in saturated emergency rooms and overloaded laboratories is difficult. Second, no evidence-based antiviral treatment for COVID-19 has been developed in the setting of a highly stressful situation. Together, these factors may have prompted clinicians to prescribe broad-spectrum antimicrobials more often than they may otherwise have. Therefore, antimicrobial stewardship approaches urgently need to be reinforced during the COVID-19 pandemic. 4 To date, however, no study has evaluated the impact of the COVID-19 pandemic on antibiotic consumption. We conducted a before-and-after cross-sectional study comparing data in 2019 (before the COVID-19 pandemic began) and 2020 (COVID-19) for the periods from January 1 to April 30. Bellvitge University Hospital is a 700-bed hospital that serves as a public referral center of 1 million inhabitants in Catalonia, the second worst pandemic-affected area in Spain. 5 As of April 30, 2020, this hospital had had >1,293 hospital admissions for COVID-19, with a 317% increase in critical care bed use. In this study, we calculated the defined daily dose per 100 patient days, as described elsewhere, and based on the dispensing data of our electronic prescribing system. Medians for continuous variables were compared using the Wilcoxon log-rank test.

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

“…This fact could be explained by the presence of patients with severe disease, long hospital stays, and hospital-acquired infections. This phenomenon has been proposed by other authors in previous studies [23,28].…”

Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic

“…1 Another single-center study from Spain showed increased use of amoxicillin-clavulanate during the early phase of the pandemic, followed by later increased utilization of broad-spectrum antibiotics. 2 There are several potential explanations for the observed increases in antimicrobial use including concerns of bacterial co-infection in suspected or newly diagnosed COVID-19 patients, increased risk of nosocomial infection due to administration of immunomodulatory therapy, reluctance to obtain diagnostic respiratory specimens, 3 diversion of clinical resources from stewardship activities during a time of crisis, and an increased proportion of hospitalizations being due to respiratory infections which typically prompt antibiotic therapy. Our finding that increases in antibiotic use were generalized across the VA and not restricted to facilities in areas with the highest case burden of COVID-19 suggests that issues not directly related to the care of COVID-19 patients contribute to the increased density of antibiotic use.…”

“…Reports of increased antibiotic use during the COVID-19 pandemic have generally been from heavily impacted facilities or geographic regions and provide few details regarding patterns of antibiotic use. [1][2][3] To provide a broader overview of changes in antibiotic use in a healthcare system with a long-standing enterprise-wide commitment to antibiotic stewardship, we compared patterns of antibiotic use throughout the VA from January-May 2020 with corresponding time periods in prior years.…”

Impact of the pandemic on antimicrobial consumption patterns

“…Abelenda-Alonso et al 6 showed an increase in amoxicillin/clavulanate and broad-spectrum antibiotic use within the pandemic period between 2019 and 2020. These data are similar to antimicrobial consumption data in our study, which suggests the same global behavior regarding their prescription.…”