Impact of COVID-19 pandemic on antifungal consumption: a multicenter retrospective analysis

Bienvenu, Anne‐Lise; Bestion, Audrey; Pradat, Pierre; Richard, Jean‐Christophe; Argaud, Laurent; Guichon, Céline; Roux, Sandrine; Piriou, Vincent; Paillet, C.; Leboucher, Gilles

doi:10.1186/s13054-022-04270-z

Cited by 9 publications

(8 citation statements)

References 9 publications

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“…For antifungals, our data showed decreased consumption during 2020–2021. This outcome was unexpected since other authors have reported increased incidences of invasive fungal diseases in COVID-19 patients, with voriconazole the first-line treatment [ 36 ]. Nevertheless, we found that the used amount of this antifungal in Portugal displayed a negative rate of −7% for 2020 but a positive rate of 12% for 2021 compared with 2019.…”

Section: Discussionmentioning

confidence: 95%

Predicted Environmental Risk Assessment of Antimicrobials with Increased Consumption in Portugal during the COVID-19 Pandemic; The Groundwork for the Forthcoming Water Quality Survey

et al. 2023

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The environmental release of antimicrobial pharmaceuticals is an imminent threat due to ecological impacts and microbial resistance phenomena. The recent COVID-19 outbreak will likely lead to greater loads of antimicrobials in the environment. Thus, identifying the most used antimicrobials likely to pose environmental risks would be valuable. For that, the ambulatory and hospital consumption patterns of antimicrobials in Portugal during the COVID-19 pandemic (2020–2021) were compared with those of 2019. A predicted risk assessment screening approach based on exposure and hazard in the surface water was conducted, combining consumption, excretion rates, and ecotoxicological/microbiological endpoints in five different regions of Portugal. Among the 22 selected substances, only rifaximin and atovaquone demonstrated predicted potential ecotoxicological risks for aquatic organisms. Flucloxacillin, piperacillin, tazobactam, meropenem, ceftriaxone, fosfomycin, and metronidazole showed the most significant potential for antibiotic resistance in all analysed regions. Regarding the current screening approach and the lack of environmental data, it is advisable to consider rifaximin and atovaquone in subsequent water quality surveys. These results might support the forthcoming monitorisation of surface water quality in a post-pandemic survey.

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Section: Discussionmentioning

confidence: 95%

Predicted Environmental Risk Assessment of Antimicrobials with Increased Consumption in Portugal during the COVID-19 Pandemic; The Groundwork for the Forthcoming Water Quality Survey

et al. 2023

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Section: Introductionmentioning

confidence: 99%

“…The recent COVID-19 pandemic and the risk of the patient becoming immunocompromised with a risk of systemic fungal infection highlighted the need for antifungal stewardship programs to prevent and fight unwarranted systemic infections [ 32 , 33 ]. Antifungal consumption during COVID-19 was evidenced to be increased [ 33 , 34 ]. However, a UK study reported that despite the COVID-19 pandemic’s effect on increasing antifungal consumption, the standards of care were good as a result of the presence of technology to facilitate antifungal stewardship programs [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review

Albahar,

Alhamad,

Abu Assab

et al. 2023

TropicalMed

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Background: Antimicrobial stewardship programs (ASP) have been proposed as an opportunity to optimize antifungal use. The antifungal resistance is a significant and emerging threat. The literature on antifungal stewardship (AFS) and its influence on performance and clinical outcome measures is scarce. This study aimed to examine global evidence of the impact of AFS on patients and performance measures. Methods: The “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) was used for the flow of identification, screening, eligibility, and inclusion. PubMed and MEDLINE were searched using the term ‘‘antifungal stewardship’’ on 15 February 2023. Search terms included antifungal stewardship, antimicrobial stewardship, candida, candidemia, candiduria, and invasive fungal disease. Of the 1366 records, 1304 were removed since they did not describe an antifungal stewardship intervention. Among the 62 full texts assessed, 21 articles were excluded since they were non-interventional studies and did not include the outcome of interest. Thus, 41 articles were eligible for systematic review. Eligible studies were those that described an AFS program and evaluated clinical or performance measures. Results: Of the 41 included studies, the primary performance measure collected was antifungal consumption (22 of 41), and mortality (22 of 41), followed by length of stay (11 of 41) and cost (9 of 41). Most studies were single-center, quasi-experimental, with varying interventions across studies. The principal finding from most of the studies in this systematic review is a reduction in mortality expressed in different units and the use of antifungal agents (13 studies out of 22 reporting mortality). Antifungal consumption was significantly blunted or reduced following stewardship initiation (10 of 22). Comparing studies was impossible due to a lack of standard units, making conducting a meta-analysis unfeasible, which would be a limitation of our study. Conclusion: It has been shown that AFS interventions may improve antifungal consumption and other performance measures. According to available published studies, antifungal consumption and mortality appear to be the possible performance measures to evaluate the impact of AFS.

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“…While most reviews to date have focused on antibacterial use during the COVID-19 pandemic, we hypothesize that the pandemic also impacted the use of antifungal agents in critically ill patients. Limited data from Spain and France found elevation in the use of several mold-active antifungals, including amphotericin B, echinocandins, and voriconazole [ 18 , 19 ]. To date, only a single review analyzed trends of antifungal usage in the United States.…”

Section: Introductionmentioning

confidence: 99%

Missed Opportunities for Antifungal Stewardship during the COVID-19 Era

Hawkins,

Walker,

Shorman

2023

Antibiotics

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Significant increases in antibacterial use were observed during the COVID-19 pandemic. However, subsequent analyses found this increase in antibiotic use to be excessive in comparison with the relatively low rates of bacterial coinfection. Although patients who are critically ill with COVID-19 may be at an increased risk for pulmonary aspergillosis, antifungal use in these populations remained underreported, particularly in later phases of the pandemic. This single-center, population-level cohort analysis compares the monthly use rates of mold-active antifungal drugs in the medical intensive care unit during April 2019–March 2020 (baseline) with those during April 2020–November 2022. The antifungal drugs included in the analysis were liposomal amphotericin B, anidulafungin, isavuconazonium, posaconazole, and voriconazole. We found that during 2020–2022, the usage of antifungal drugs was not significantly different from baseline for all included agents except isavuconazonium, which was used significantly more (p = 0.009). There were no changes in diagnostic modalities between the two time periods. The reported prevalence of and mortality from COVID-19-associated pulmonary aspergillosis (CAPA) may have resulted in higher rates of prescribing antifungal drugs for critically ill patients with COVID-19. Antimicrobial stewardship programs should develop and apply tools to facilitate more effective and appropriate antifungal use.

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Impact of COVID-19 pandemic on antifungal consumption: a multicenter retrospective analysis

Cited by 9 publications

References 9 publications

Predicted Environmental Risk Assessment of Antimicrobials with Increased Consumption in Portugal during the COVID-19 Pandemic; The Groundwork for the Forthcoming Water Quality Survey

Predicted Environmental Risk Assessment of Antimicrobials with Increased Consumption in Portugal during the COVID-19 Pandemic; The Groundwork for the Forthcoming Water Quality Survey

The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review

Missed Opportunities for Antifungal Stewardship during the COVID-19 Era

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