Antimicrobial consumption among hospitalized patients with COVID-19 in Pakistan

Mustafa, Zia Ul; Salman, Muhammad; Aldeyab, Mamoon A.; Kow, Chia Siang; Hasan, Syed Shahzad

doi:10.1007/s42399-021-00966-5

Cited by 49 publications

(56 citation statements)

References 14 publications

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“…On the other hand, there was increased use of other antibiotics compared with the pre-COVID-19 period (i.e., third-generation cephalosporins, carbapenems, macrolides, and lincosamides). Similar findings were observed in other studies [17,[23][24][25]. This increase is of importance since their use has been linked to the development of resistance in several studies [1,[4][5][6]26].…”

Section: Discussionsupporting

confidence: 88%

An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan

et al. 2021

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Coronavirus disease 2019 (COVID-19) has overlapping clinical characteristics with bacterial respiratory tract infection, leading to the prescription of potentially unnecessary antibiotics. This study aimed at measuring changes and patterns of national antimicrobial use for one year preceding and one year during the COVID-19 pandemic. Annual national antimicrobial consumption for 2019 and 2020 was obtained from the Jordan Food and Drug Administration (JFDA) following the WHO surveillance methods. The WHO Access, Watch, and Reserve (AWaRe) classification was used. Total antibiotic consumption in 2020 (26.8 DDD per 1000 inhabitants per day) decreased by 5.5% compared to 2019 (28.4 DDD per 1000 inhabitants per day). There was an increase in the use of several antibiotics during 2020 compared with 2019 (third generation cephalosporins (19%), carbapenems (52%), macrolides (57%), and lincosamides (106%)). In 2020, there was a marked reduction in amoxicillin use (−53%), while the use of azithromycin increased by 74%. National antimicrobial consumption of the Access group decreased by 18% from 2019 to 2020 (59.1% vs. 48.1% of total consumption). The use of the Watch group increased in 2020 by 26%. The study highlighted an increase in the use of certain antibiotics during the pandemic period that are known to be associated with increasing resistance. Efforts to enhance national antimicrobial stewardship are needed to ensure rational use of antimicrobials.

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Section: Discussionsupporting

confidence: 88%

An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan

et al. 2021

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“…Barrier precautions, increased focus on hygiene, environmental cleaning, patient isolation and the increased use of PPE, have certainly played an important role in preventing C. difficile transmission, despite the increased/inappropriate use of broad-spectrum antibiotics, with about 70% of patients with COVID-19 subjected to antibiotic therapy mainly for the suspected acquisition of secondary bacterial infections [ 36 , 37 ]. However, it has to be considered that some antibiotics, such as azithromycin, are more extensively used compared with others for treatment of COVID-19 patients [ [38] , [39] , [40] ]. Although treatment with any antibiotic may precede the development of CDI, certain antibiotic classes have higher rates of association and, in addition, the associated CDI risk can be different within the same class [ 41 ].…”

Section: And the Covid-19 Pandemicmentioning

confidence: 99%

“…A final consideration is with regards to the heavy burden of the current pandemic on antimicrobial stewardship activities. The overused of antibiotics reported in the recent past [ 38 , 39 , 72 ] has raised several concerns about the consequent selection and increase in the AMR in pathogenic bacteria. In particular, C. difficile, as a possible component of the intestinal microflora of patients, may be subjected to “bystander selection”, a selective pressure for resistance due to antibiotic exposure for a condition caused by other species [ 73 ], with a consequent selection of resistant C. difficile strains.…”

Section: What About CDI In the Next Future?mentioning

confidence: 99%

Clostridioides difficile infection (CDI) during the COVID-19 pandemic

Spigaglia

2022

Anaerobe

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The ongoing coronavirus disease (COVID-19) pandemic has dramatically tested healthcare systems around the world, with serious repercussions on the measures of prevention and control of hospital-acquired infections (HAIs). Among HAIs, Clostridioides difficile infection (CDI) represents one of the most important global public health threats. Although the full impact of the COVID-19 pandemic on CDI remains undetermined, depending on the development of the pandemic in the coming months, in this review literature studies of the last three years have been considered in order to depict the current situation, and make some considerations about possible future developments. If on the one hand, a general reduction in CDI incidence has been reported in several settings, mainly due to the extraordinary reinforcement of infection prevention measures, on the other hand, the critical circumstances experienced in many hospitals have limited the effectiveness of these measures, particularly in the intensive care units (ICUs), increasing the possibility of the occurrence of hospital-acquired CDI (HA-CDI). New concerns have arisen from the decrease in C. difficile testing and the increased use of broad-spectrum antibiotics reported during the pandemic. In particular, overuse of antibiotics and disinfectants may lead to a selection of resistant C. difficile strains not only in hospitals but also in the community. Furthermore, patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and patients that have survived COVID-19 may represent a new group of frail patients potentially at a higher risk of CDI, a group that could potentially increase in size due to SARS-CoV-2 evolution. In the dramatic COVID-19 era, the multifactorial nature of CDI has emerged more clearly than before, highlighting the necessity of a strong refocus on efforts to improve prevention strategies and to integrate CDI surveillance in a One Health prospective in order to curtail the public health threat posed by this infection in the next future.

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“…The usage of antibiotics was higher during the COVID-19 pandemic as compared to the pre-pandemic period: the consumption of azithromycin raised from 11.5 daily define doses (DDD) per 100 occupied bed-days in 2019 to 17.0 DDDs per 100 occupied bed-days in 2020, while the administration of ceftriaxone escalated from 20.2 DDDs per 100 occupied bed-days in 2019 to 25.1 DDDs per 100 occupied bed-days in 2020. 16 This can be alarming and warrants strict health interventions and their implementations by the stake holders.…”

Section: Page-60mentioning

confidence: 99%