Evidences on Irrational Anti-Microbial Prescribing and Consumption among COVID-19 Positive Patients and Possible Mitigation Strategies: A Descriptive Cross Sectional Study

Parveen, Monira; Molla, Md. Maruf Ahmed; Yeasmin, Mahmuda; Nafisa, Tasnim; Barna, Arifa Akram; Ghosh, Asish Kumar

doi:10.3329/bjid.v7i00.50155

Cited by 11 publications

(10 citation statements)

References 16 publications

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“…In Bangladesh, during the early months of the pandemic, there were reports of widespread antimicrobial consumption among COVID-19 positive and suspected patients-in most cases even without a prescription from a certified physician. In a previous study conducted among Bangladeshi COVID-19 patients isolating at home with mild or asymptomatic infection, 63% received one or more antimicrobial agents, including investigational drugs such as ivermectin, remdesivir, and favipiravir [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Molla¹,

Yeasmin²,

Islam

et al. 2021

Infection Prevention in Practice

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Background: As evidence is mounting regarding irrational and often unnecessary use of antibiotics during the COVID-19 pandemic a cross-sectional Point Prevalence Survey (PPS) (in accordance with WHO guideline) was conducted across COVID-19 dedicated wards in Dhaka Medical College and Hospital (DMCH). Methodology: Antibiotic usage data were collected from 193 patients at different COVID-19 dedicated wards at DMCH on 11 June 2020. Comparisons in antibiotic usage were made between different groups using Pearson chi-square and Fisher’s exact test. Result: Findings reveal all surveyed patients (100%) were receiving at least one antibiotic with 133 patients (68.91%) receiving multiple antibiotics. Overall, patients presenting with the severe disease received more antibiotics. Third-generation cephalosporins (i.e. ceftriaxone) (53.8%), meropenem (40.9%), moxifloxacin (29.5%), and doxycycline (25.4%) were the four most prescribed antibiotics among surveyed patients. Diabetes mellitus (DM) was independently associated with multiple antibiotic prescribing. Abnormal C-reactive protein (CRP) and serum d-dimer were linked with higher odds of multiple antibiotic prescribing among study patients. Conclusion: Prevalence of multiple antibiotic prescriptions was high among severely ill patients and those with abnormal CRP and d-dimer levels. Data regarding the quality of antibiotic prescribing were lacking.

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Section: Discussionmentioning

confidence: 99%

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Molla¹,

Yeasmin²,

Islam

et al. 2021

Infection Prevention in Practice

Self Cite

View full text Add to dashboard Cite

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“…Moreover, there is a scarcity of data regarding antimicrobial use among hospital admitted suspected COVID-19 patients in Bangladesh. Available studies reported antibiotic use among confirmed COVID-19 patients, suggesting a wide range of antibiotic use during the COVID-19 pandemic [ 35 , 36 ]. Considering the scarcity of antimicrobial data in this overstressing COVID-19 pandemic situation in Bangladesh, we assessed the proportion of antimicrobial use and factors associated with antibiotic use among suspected COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

Use of Antimicrobials among Suspected COVID-19 Patients at Selected Hospitals, Bangladesh: Findings from the First Wave of COVID-19 Pandemic

et al. 2021

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Antimicrobials are empirically used in COVID-19 patients resulting in increased antimicrobial resistance. Our objective was to assess antimicrobial use among suspected COVID-19 in-patients. From March to August 2020, we collected data from in-patients of 12 tertiary-level hospitals across Bangladesh. We identified suspected COVID-19 patients; collected information on antimicrobial received within 24 h before and on hospitalization; tested nasopharyngeal swab for SARS-CoV-2 using rRT-PCR. We used descriptive statistics and a regression model for data analysis. Among 1188 suspected COVID-19 patients, 69% were male, 40% had comorbidities, and 53% required oxygen. Antibiotics were used in 92% of patients, 47% within 24 h before, and 89% on admission. Patients also received antiviral (1%) and antiparasitic drugs (3%). Third-generation cephalosporin use was the highest (708; 60%), followed by macrolide (481; 40%), and the majority (853; 78%) who took antibiotics were SARS-CoV-2 negative. On admission, 77% mild and 94% moderately ill patients received antibiotics. Antibiotic use on admission was higher among severely ill patients (AOR = 11.7; 95% CI: 4.5–30.1) and those who received antibiotics within 24 h before hospital admission (AOR = 1.6; 95% CI: 1.0–2.5). Antimicrobial use was highly prevalent among suspected COVID-19 in-patients in Bangladesh. Initiating treatment with third-generation cephalosporin among mild to moderately ill patients was common. Promoting antimicrobial stewardship with monitoring is essential to prevent blanket antibiotic use, thereby mitigating antimicrobial resistance.

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“…75 Broad-spectrum antimicrobial agents are prescribed at high rates to combat bacterial and fungal coinfection. 75 Azithromycin, ivermectin, and doxycycline were the most frequently used antibiotics in Bangladesh 76 and worldwide. 77 Methylation mediated by methylases encoded by erm genes (especially ermA and ermB) are responsible for Azithromycin 78 Overall, this approach provides valuable insights on the composition of the respiratory microbiome from both vaccinated and nonvaccinated patients and picturizes its relationship with coinfections and/or other organisms that may have a significant impact on SARS-CoV-2 disease progression and prognosis.…”

Section: Discussionmentioning

confidence: 99%

Genomic characterization of the dominating Beta, V2 variant carrying vaccinated (Oxford−AstraZeneca) and nonvaccinated COVID‐19 patient samples in Bangladesh: A metagenomics and whole‐genome approach

Rahaman

Sarkar

Rahman³

et al. 2022

Journal of Medical Virology

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Bangladesh is experiencing a second wave of COVID-19 since March 2021, despite the nationwide vaccination drive with ChAdOx1 (Oxford−AstraZeneca) vaccine from early February 2021. Here, we characterized 19 nasopharyngeal swab (NPS) samples from COVID-19 suspect patients using genomic and metagenomic approaches. Screening for SARS-CoV-2 by reverse transcriptase polymerase chain reaction and metagenomic sequencing revealed 17 samples of COVID-19 positive (vaccinated = 10, nonvaccinated = 7) and 2 samples of COVID-19 negative. We did not find any significant correlation between associated factors including vaccination status, age or sex of the patients, diversity or abundance of the coinfected organisms/pathogens, and the abundance of SARS-CoV-2. Though the first wave of the pandemic was dominated by clade 20B, Beta, V2 (South African variant) dominated the second wave (January 2021 to May 2021), while the third wave (May 2021 to September 2021) was responsible for Delta variants of the epidemic in Bangladesh including both vaccinated and unvaccinated infections. Noteworthily, the receptor binding domain (RBD) region of S protein of all the isolates harbored similar substitutions including K417N, E484K, and N501Y that signify the Beta, while D614G, D215G, D80A, A67V, L18F, and A701V substitutions were commonly found in the non-RBD region of Spike proteins. ORF7b and ORF3a genes underwent a positive selection (dN/dS ratio 1.77 and 1.24, respectively), while the overall S protein of the Bangladeshi SARS-CoV-2 isolates underwent negative selection pressure (dN/dS = 0.621). Furthermore, we found different bacterial coinfections like Streptococcus agalactiae, Neisseria meningitidis, Elizabethkingia anophelis, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Pseudomonas plecoglossicida, expressing a number of antibiotic resistance genes such as tetA and tetM. Overall, this approach provides

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Evidences on Irrational Anti-Microbial Prescribing and Consumption among COVID-19 Positive Patients and Possible Mitigation Strategies: A Descriptive Cross Sectional Study

Cited by 11 publications

References 16 publications

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Use of Antimicrobials among Suspected COVID-19 Patients at Selected Hospitals, Bangladesh: Findings from the First Wave of COVID-19 Pandemic

Genomic characterization of the dominating Beta, V2 variant carrying vaccinated (Oxford−AstraZeneca) and nonvaccinated COVID‐19 patient samples in Bangladesh: A metagenomics and whole‐genome approach

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