Antimicrobial stewardship programme: a vital resource for hospitals during the global outbreak of coronavirus disease 2019 (COVID-19)

Liew, Yi Xin; Lee, Winnie Hui Ling; Tan, Lunyi; Kwa, Andrea Lay Hoon; Thien, Siew Yee; Cherng, Benjamin Pei Zhi; Chung, Shimin Jasmine

doi:10.1016/j.ijantimicag.2020.106145

Cited by 35 publications

(34 citation statements)

References 3 publications

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“…This could be due to treating physicians' experience of using azithromycin for respiratory infections or they could be influenced by widespread off-label use of azithromycin for the treatment of COVID-19 in other countries. For example, similar findings were reported by a previous study conducted in Singapore, where similar trends of increased azithromycin consumption were reported [ 9 ]. This is concerning because acquired macrolide resistance has been an increasingly recognized problem even before the COVID-19 pandemic [ 10 ].…”

Section: Discussionsupporting

confidence: 89%

Antimicrobial consumption among hospitalized patients with COVID-19 in Pakistan

Mustafa

Salman

Aldeyab

et al. 2021

SN Compr. Clin. Med.

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The discovery of different antimicrobial agents has revolutionized the treatment against a variety of infections for many decades, but the emergence of antimicrobial resistance require rigorous measures, even amid the coronavirus disease 2019 (COVID-19) pandemic. This retrospective study aimed to examine the consumption of antibiotics in patients with COVID-19 admitted into the five hospitals in the province of Punjab, Pakistan. We collected data on the consumption of antibiotics, classified using the World Health Organization (WHO) AWaRe (Access, Watch, and Reserve), within two months—August and September, 2020, and the corresponding months in 2019. Consumption of antibiotics was presented as daily define dose (DDD) per 100 occupied bed-days. Eight different classes of antibiotics were prescribed to patients with COVID-19 without culture tests being performed, with the prescribing of antibiotics of the Watch category was especially prevalent. The consumption of antibiotics was higher during the COVID-19 pandemic compared to the pre-pandemic period: the consumption of azithromycin increased from 11.5 DDDs per 100 occupied bed-days in 2019 to 17.0 DDDs per 100 occupied bed-days in 2020, while the consumption of ceftriaxone increased from 20.2 DDDs per 100 occupied bed-days in 2019 to 25.1 DDDs per 100 occupied bed-days in 2020. The current study revealed non-evidence-based utilization of antibiotics among patients with COVID-19 admitted into the hospitals in Pakistan. Evidently, the current COVID-19 pandemic is a public health threat of notable dimensions which has compromised the ongoing antimicrobial stewardship program, potentially leading to the emergence of antimicrobial resistance among pathogens.

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Section: Discussionsupporting

confidence: 89%

Antimicrobial consumption among hospitalized patients with COVID-19 in Pakistan

Mustafa

Salman

Aldeyab

et al. 2021

SN Compr. Clin. Med.

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“…Another important finding of this study is that COVID-19 patients have a higher incidence of MDR bacterial infections compared to non-COVID-19 patients, despite the fact that IPC measures were even stricter in the first group. This finding could be explained by the widespread use of broad-spectrum antibiotics in COVID-19 patients, which may be responsible for an increase in the incidence and the selection of multidrug-resistant bacteria [17]. Furthermore, COVID-19 departments are mostly managed by infectious disease specialists, who are more likely to perform culture tests.…”

Section: Discussionmentioning

confidence: 99%

Reduction of Multidrug-Resistant (MDR) Bacterial Infections during the COVID-19 Pandemic: A Retrospective Study

Bentivegna

Luciani

Arcari³

et al. 2021

IJERPH

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Multidrug-resistant (MDR) organisms are emerging as some of the main healthcare problems worldwide. During the COVID-19 pandemic, several Infection Prevention and Control (IPC) measures have been adopted to reduce nosocomial microorganism transmission. We performed a case–control study to identify if the incidence of MDR bacterial infections while using pandemic-related preventive measures is lower than in previous years. From 2017 to 2020, we monitored hospital discharges over a four-month period (P #) (1 March to 30 June) in St. Andrea Hospital, Rome. In total, we reported 1617 discharges. Pearson’s chi-squared test was used to identify significant differences. A value of p ≤ 0.05 was considered statistically significant. A significant reduction in the incidence of total MDR bacterial infections was observed during the pandemic compared to in prepandemic years (p < 0.05). We also found a significantly higher incidence of MDR bacterial infections in COVID-19 departments compared with other medical departments (29% and 19%, respectively), with extended-spectrum β-lactamase Klebsiella pneumoniae as the pathogens presenting the highest increase. This study demonstrates that maintaining a high level of preventive measures could help tackle an important health problem such as that of the spread of MDR bacteria.

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“…In another study published by researchers from the Bellvitge University Hospital (Catalonia, Spain) [ 23 ], the COVID-19 pandemic significantly increased the overall monthly antibiotic usage compared to the previous year through March and April 2020 with a biphasic pattern: a first wave of empirical antibiotic therapy and a second one with higher use of broad-spectrum antibiotics. In Asia, data from the Singapore General Hospital, with an existing local ASP, showed a 25.5% increase in the prescription of broad-spectrum antibiotics and an increment in the average use of antibiotics in community-onset pneumonia (+2.07 DDD per 100 bed days) and the mean proportion of patients treated with antibiotics (+2.5%) during the pandemic compared to the same period in 2019 [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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During the COVID-19 pandemic, the implementation of antimicrobial stewardship strategies has been recommended. This study aimed to assess the impact of the COVID-19 pandemic in a tertiary care Spanish hospital with an active ongoing antimicrobial stewardship programme (ASP). For a 20-week period, we weekly assessed antimicrobial consumption, incidence density, and crude death rate per 1000 occupied bed days of candidemia and multidrug-resistant (MDR) bacterial bloodstream infections (BSI). We conducted a segmented regression analysis of time series. Antimicrobial consumption increased +3.5% per week (p = 0.016) for six weeks after the national lockdown, followed by a sustained weekly reduction of −6.4% (p = 0.001). The global trend for the whole period was stable. The frequency of empirical treatment of patients with COVID-19 was 33.7%. No change in the global trend of incidence of hospital-acquired candidemia and MDR bacterial BSI was observed (+0.5% weekly; p = 0.816), nor differences in 14 and 30-day crude death rates (p = 0.653 and p = 0.732, respectively). Our work provides quantitative data about the pandemic effect on antimicrobial consumption and clinical outcomes in a centre with an active ongoing institutional and education-based ASP. However, assessing the long-term impact of the COVID-19 pandemic on antimicrobial resistance is required.

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Antimicrobial stewardship programme: a vital resource for hospitals during the global outbreak of coronavirus disease 2019 (COVID-19)

Cited by 35 publications

References 3 publications

Antimicrobial consumption among hospitalized patients with COVID-19 in Pakistan

Antimicrobial consumption among hospitalized patients with COVID-19 in Pakistan

Reduction of Multidrug-Resistant (MDR) Bacterial Infections during the COVID-19 Pandemic: A Retrospective Study

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

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