Impact of the COVID-19 pandemic on hospital antimicrobial consumption in Croatia

Abstract

Objectives The aim of the study was to assess the impact of the COVID-19 pandemic on antimicrobial consumption (AMC) in the hospital sector in Croatia by analysing data reported to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) between 2016 and 2020. Methods AMC was measured as the number of DDDs/1000 inhabitants/day and as the number of DDDs/100 bed days. To assess trends, linear regression was performed. To assess the impact of the pandemic on AMC, the compound annual growth rate was calculated for the years preceding the pandemic based on which AMC for 2020 was forecasted and compared with the actual consumption. Results While hospital AMC expressed as DDDs/1000 inhabitants/day between 2019 and 2020 decreased by 17%, when expressed as DDDs/100 bed days, an 8% increase was observed. Hospital consumption of antibacterials for systemic use in the 5 year period did not significantly change when expressed as DDDs/1000 inhabitants/day, while it statistically significantly increased when expressed as DDDs/100 bed days. An increasing trend in consumption of broad-spectrum antimicrobials was found. Conclusions During the pandemic there was an increase in hospital AMC with a shift towards broad-spectrum antimicrobials requiring further in-depth qualitative analysis based on patient-level data. Contrasting results obtained using different denominators indicate that the metric DDDs/1000 inhabitants/day is not sensitive enough to evaluate hospital AMC. When assessing hospital AMC, the population under surveillance should be relevant for healthcare context. Antimicrobial stewardship remains one of the most important strategies to tackle antimicrobial resistance and antimicrobial surveillance methods must be as sensitive as possible.

Hospital Antibiotic Consumption before and during the COVID-19 Pandemic in Hungary

“…Restrictions and people's fear of the virus could have also contributed to the decrease in hospital admissions. Studies on hospital antibiotic use during the pandemic years are scarce [5][6][7][8][9][10][11][12][13][14]. Most of the studies were from western European countries like Sweden, Switzerland, and Italy.…”

“…Most of the studies were from western European countries like Sweden, Switzerland, and Italy. From Central Europe, only one Croatian study has been published so far [8]. Most of these studies focused on the first year [7,9,10,12,13] or months [8,11,13] of the COVID-19 pandemic.…”

“…From Central Europe, only one Croatian study has been published so far [8]. Most of these studies focused on the first year [7,9,10,12,13] or months [8,11,13] of the COVID-19 pandemic. Some studies focused on a single clinical centre [12,14], one involved a subset of hospitals in the data analysis [13], while others reported national-level data from hospitals [7][8][9][10][11].…”

“…Most of these studies focused on the first year [7,9,10,12,13] or months [8,11,13] of the COVID-19 pandemic. Some studies focused on a single clinical centre [12,14], one involved a subset of hospitals in the data analysis [13], while others reported national-level data from hospitals [7][8][9][10][11]. These drug utilisation studies revealed an increase in hospital antibiotic use during the pandemic [7][8][9][10][12][13][14].…”

“…Some studies focused on a single clinical centre [12,14], one involved a subset of hospitals in the data analysis [13], while others reported national-level data from hospitals [7][8][9][10][11]. These drug utilisation studies revealed an increase in hospital antibiotic use during the pandemic [7][8][9][10][12][13][14]. There was concern that the excessive prescription and improper use of antibiotics during the pandemic could worsen the already significant problem of antibiotic resistance.…”