Effects of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial prevalence and prescribing in a tertiary hospital in Singapore

Abstract

Background The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing. Methods One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017–2019. Results The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08). Conclusion During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.

Antibiotic Use in China’s Public Healthcare Institutions During the COVID-19 Pandemic: An Analysis of Nationwide Procurement Data, 2018–2020

“…In China, the influence factors and their interaction relation of antibiotics use under the COVID-19 pandemic were becoming clear ( Figure 7 ). The shock of COVID-19 in 2020 led to significant decline in antibiotic consumption around the world ( Swedres-Svarm, 2020 ; Blix and Høye, 2021 ; Buehrle et al, 2021 ; ECDC, 2021 ; Gagliotti et al, 2021 ; Hogberg et al, 2021 ; King et al, 2021 ; Ng et al, 2021 ; Penalva et al, 2021 ; Sundhedsdatastyrelsen, 2021 ), and China is no exception. The decreases of antibiotic consumption during the COVID-19 pandemic might be due to the declined infectious diseases incidence caused by non-pharmaceutical interventions (NPIs) introduced to reduce COVID-19 transmission ( Swedres-Svarm, 2020 ; Gagliotti et al, 2021 ; Penalva et al, 2021 ; Ullrich et al, 2021 ), as well as the reduction of medical service contact and the compression of irrational prescriptions during the pandemic lockdown.…”

“…The generalized linear model (GLM) was used to examine the change of health facilities’ antibiotic consumption under the impact of the COVID-19 pandemic. According to previous studies, the impact of the COVID-19 pandemic on the use of antibiotics in medical institutions might be related to the drug treatment of COVID-19 cases ( Li et al, 2020 ; Langford et al, 2021 ) and the decline of medical services due to COVID-19 control measures ( Buehrle et al, 2021 ; ECDC, 2021 ; Hogberg et al, 2021 ; King et al, 2021 ; Ng et al, 2021 ). Thus, two variables (medical service decline and number of COVID-19 cases under treatment) were selected as the indirect measures of the COVID-19 pandemic to estimate the change of antibiotic use at the population level.…”

“…In the United States, nationwide studies reported the substantial decline of antibiotic prescribing of outpatients during the COVID-19 pandemic (Buehrle et al, 2021;King et al, 2021). These findings from EU/EEA countries, Singapore, and the United States consistently mentioned that the significant reduction in the use of systemic antibiotics during the COVID-19 pandemic might be attributed to infection control measures and reduced contact with the health service (Swedres-Svarm, 2020; Blix and Høye, 2021;Buehrle et al, 2021;ECDC, 2021;Gagliotti et al, 2021;Hogberg et al, 2021;King et al, 2021;Ng et al, 2021;Penalva et al, 2021).…”

“…The unprecedented decrease in community antibiotic consumption noted for all groups of antibiotics in nearly all EU/EEA countries is the largest in ESAC-Net (European Surveillance of Antimicrobial Consumption Network)’s two-decade long antimicrobial consumption surveillance history, and one example of the far-reaching consequences of the COVID-19 pandemic ( Hogberg et al, 2021 ). Evidence from Singapore revealed that the antimicrobial utilization in hospitals significantly reduced by 361.46 DDD/1000 patient days/month before and after the peak of the COVID-19 pandemic ( Ng et al, 2021 ). In the United States, nationwide studies reported the substantial decline of antibiotic prescribing of outpatients during the COVID-19 pandemic ( Buehrle et al, 2021 ; King et al, 2021 ).…”

Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital

“…Therefore antimicrobial monitoring use in the case of the pandemic is crucial to identify concerning signs of misuse or overuse. Studies conducted in several countries found an increase in antimicrobial consumption in ICUs during the pandemic (Guisado-Gil et al, 2020;Rawson et al, 2020;Grau et al, 2021b;Ng et al, 2021).…”