Change in hospital antibiotic use and acquisition of multidrug-resistant gram-negative organisms after the onset of coronavirus disease 2019

Abstract

Interrupted time series segmented regression was conducted to trend antibiotic use and multidrug-resistant gram-negative (MDRGN) acquisition relative to COVID-19 in an academic hospital. Total antibiotic use and antibiotic use related to pneumonia was higher in the period after the onset of COVID-19 compared to the similar calendar period in 2019. Furthermore, MDRGN acquisition increased 3% for every increase in positive COVID-19 tests per week.

The Complexity of Co-Infections in the Era of COVID-19

“…Empiric, potent, or prolonged antibiotic therapy increases risk for nosocomial infection. In addition, the COVID-19 context has been significantly associated with increasing antibiotic use [119][120][121]. The presence of a potentially complex infection along with the use of either steroids or immunomodulatory treatments otherwise increases the potential for secondary bacterial infections.…”

“…The COVID-19 experience on this theme is considerable to date. Empiric antibiotic use is common among these patients [76,[119][120][121]131]. The frequency of such use may decline with experience [76].…”

“…Common respiratory bacteria more often cause infection in early stages of the illness [75,125,129,133,[141][142][143]. Nosocomial infections can be common as the viral illness progresses albeit the institutional rate is quite variable [49,118,119,123,131,[135][136][137][138][139][140][144][145][146][147]. Much of the latter includes opportunistic Gram-negative bacilli [49,100,118,119,123,124,126,137,138,140,144,145,147,148].…”

“…Nosocomial infections can be common as the viral illness progresses albeit the institutional rate is quite variable [49,118,119,123,131,[135][136][137][138][139][140][144][145][146][147]. Much of the latter includes opportunistic Gram-negative bacilli [49,100,118,119,123,124,126,137,138,140,144,145,147,148]. Fungal infections, especially with Candida spp., occur with worse disease and increased hospital stay [118,126,135,136,139,144,145,147,[149][150][151].…”

Antimicrobial multidrug resistance in the era of COVID-19: a forgotten plight?

“…Protocols for prevention, early detection and treatment of infectious complications need to be adhered to, and principally, antimicrobial stewardship programmes need to be integrated into future emergency response preparedness efforts [15]. Ultimately, the intense hospital use of antibiotics in COVID-19 patients at the early stage of the pandemic may influence the level of bacterial resistance [16], impacting the burden of disease well into the future.…”