Antibiotic Use during the COVID-19 Pandemic in a Tertiary Hospital with an Ongoing Antibiotic Stewardship Program

Henig, Oryan; Kehat, Orli; Meijer, Suzy E; Chikly, Amanda; Weiss-Meilik, Ahuva; Egoz, Eyal; Ben‐Ami, Ronen; Paran, Yael

doi:10.3390/antibiotics10091056

Cited by 15 publications

(19 citation statements)

References 20 publications

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“…For example, antibiotic consumption was highest during the first wave, probably due to the uncertainty of how to treat COVID-19 patients [ 9 ], followed by a decline with the introduction of more specific treatment guidelines. This was also found in a study from Israel, where a continuous decrease in antibiotic consumption from wave to wave was observed [ 27 ]. However, especially for the sales data, an amplification of this effect by buying antibiotics in stock at the beginning of the pandemic cannot be ruled out.…”

Section: Discussionsupporting

confidence: 79%

“…At the beginning of the pandemic, due to the high occupancy rate of ICUs and general uncertainty about the treatment of COVID-19 patients, treating physicians may have tended to prescribe broad-spectrum antibiotics leading to increased prescribing of these antibiotics. As the pandemic progressed and the treatment of COVID-19 patients became more routine, this initially high consumption was adjusted—an aspect that is also supported by a study by Henig et al [ 27 ].…”

Section: Discussionmentioning

confidence: 72%

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Impact of the COVID-19 Pandemic on Inpatient Antibiotic Consumption in Switzerland

et al. 2022

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The aim of this study was to analyze inpatient antibiotic consumption during the first 16 months of the COVID-19 pandemic in Switzerland. The entire period (January 2018–June 2021) was divided into the prepandemic period, the first and second waves, and the intermediate period. In the first year of the pandemic, total overall inpatient antibiotic consumption measured in defined daily doses (DDD) per 100 bed-days remained stable (+1.7%), with a slight increase in ICUs of +4.2%. The increase in consumption of broad-spectrum antibiotics was +12.3% overall and 17.3% in ICUs. The segmented regression model of monthly data revealed an increase in overall antibiotic consumption during the first wave but not during the second wave. In the correlation analysis performed in a subset of the data, a significant positive association was found between broad-spectrum antibiotic consumption and an increasing number of hospitalized COVID-19 patients (p = 0.018). Restricting this dataset to ICUs, we found significant positive correlations between the number of hospitalized COVID-19 patients and total antibiotic consumption (p = 0.007) and broad-spectrum antibiotic consumption (p < 0.001). In conclusion, inpatient antibiotic use during the different periods of the COVID-19 pandemic varied greatly and was predominantly notable for broad-spectrum antibiotics.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 72%

Impact of the COVID-19 Pandemic on Inpatient Antibiotic Consumption in Switzerland

et al. 2022

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“…For example, in Israel, Henig et al described how they shifted the stewardship focus to the COVID-19 departments. In that setting, an intense stewardship program resulted in reduced antibiotic consumption through implementing new local guidelines and providing daily input from infectious disease consultants [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic

et al. 2022

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At the start of the COVID-19 pandemic, there was an increase in the use of antibiotics for the treatment of community-acquired respiratory tract infection (CA-ARI) in patients admitted for suspected or confirmed COVID-19, raising concerns for misuse. These antibiotics are not under the usual purview of the antimicrobial stewardship unit (ASU). Serum procalcitonin, a biomarker to distinguish viral from bacterial infections, can be used to guide antibiotic recommendations in suspected lower respiratory tract infection. We modified our stewardship approach, and used a procalcitonin-guided strategy to identify “high yield” interventions for audits in patients admitted with CA-ARI. With this approach, there was an increase in the proportion of patients with antibiotics discontinued within 4 days (16.5% vs. 34.9%, p < 0.001), and the overall duration of antibiotic therapy was significantly shorter [7 (6–8) vs. 6 (3–8) days, p < 0.001]. There was a significant decrease in patients with intravenous-to-oral switch of antibiotics to “complete the course” (45.3% vs. 34.4%, p < 0.05). Of the patients who had antibiotics discontinued, none were restarted on antibiotics within 48 h, and there was no-30-day readmission or 30-day mortality attributed to respiratory infection. This study illustrates the importance of the antimicrobial stewardship during the pandemic and the need for ASU to remain attuned to prescriber’s practices, and adapt accordingly to address antibiotic misuse to curb antimicrobial resistance.

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“…The first case of coronavirus disease 2019 (COVID- 19) in Canada was identified on January 23, 2020, in Toronto, Canada. 1 From that point forward, COVID-19 cases waxed and waned throughout the city, which is Canada's largest city by population and one of the country's epicenters during the COVID-19 pandemic.…”

mentioning

confidence: 99%

“…[12][13][14][15] Although some published data are available from the inpatient setting (generally demonstrating increased rates of antimicrobial prescribing during the first wave of the COVID-19 pandemic), most of these studies have only described early pandemic prescribing, and antibiotic use metrics were not always standardized to patient volumes or compared to baseline prescribing patterns. [16][17][18][19] Published data on the impact of the pandemic on ASPs, and how changes in ASPs may have affected antimicrobial consumption trends, are also limited. One study, which demonstrated a decrease in antimicrobial prescribing in COVID-19 units compared to historical controls, hypothesized that the ASP was responsible for the decreased rates of antimicrobial use.…”

mentioning

confidence: 99%

Trends in hospital antibiotic utilization during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter interrupted time-series analysis

Elligsen

Wan

Lam

et al. 2022

ASHE

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Objective: To describe the evolution of respiratory antibiotic prescribing during the coronavirus disease 2019 (COVID-19) pandemic across 3 large hospitals that maintained antimicrobial stewardship services throughout the pandemic. Design: Retrospective interrupted time-series analysis. Setting: A multicenter study was conducted including medical and intensive care units (ICUs) from 3 hospitals within a Canadian epicenter for COVID-19. Methods: Interrupted time-series analysis was used to analyze rates of respiratory antibiotic utilization measured in days of therapy per 1,000 patient days (DOT/1,000 PD) in medical units and ICUs. Each of the first 3 waves of the pandemic were compared to the baseline. Results: Within the medical units, use of respiratory antibiotics increased during the first wave of the pandemic (rate ratio [RR], 1.76; 95% CI, 1.38–2.25) but returned to the baseline in waves 2 and 3 despite more COVID-19 admissions. In ICU, the use of respiratory antibiotics increased in wave 1 (RR, 1.30; 95% CI, 1.16–1.46) and wave 2 of the pandemic (RR, 1.21; 95% CI, 1.11–1.33) and returned to the baseline in the third wave, which had the most COVID-19 admissions. Conclusions: After an initial surge in respiratory antibiotic prescribing, we observed the normalization of prescribing trends at 3 large hospitals throughout the COVID-19 pandemic. This trend may have been due to the timely generation of new research and guidelines developed with frontline clinicians, allowing for the active application of new research to clinical practice.

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Antibiotic Use during the COVID-19 Pandemic in a Tertiary Hospital with an Ongoing Antibiotic Stewardship Program

Cited by 15 publications

References 20 publications

Impact of the COVID-19 Pandemic on Inpatient Antibiotic Consumption in Switzerland

Impact of the COVID-19 Pandemic on Inpatient Antibiotic Consumption in Switzerland

Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic

Trends in hospital antibiotic utilization during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter interrupted time-series analysis

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