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

Abstract

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.

Evolution of Antimicrobial Consumption During the First Wave of COVID-19 Pandemic

“…The use of fluconazole and echinocandins also increased during the studied period, which may have been due to their empiric use for candidemia. However, one study showed that no variation was observed in its incidence between the period before the pandemic and the first wave of COVID-19 [ 6 ]. An increase in the prescription of mold active molecules was also noticed, which may be associated with a rise in the diagnosis of invasive aspergillosis in severe patients with acute respiratory distress syndrome and COVID-19 [ 25 ].…”

“…During the first wave of the pandemic, the hospital increased its capacity to a total of 861 beds, 85 of which were for critically ill patients (expanded ICU). As has been described in other Spanish hospitals [ 6 ], during the COVID-19 pandemic, the ASP team modified its routine daily practice to attend pandemic management, so no ASP was formally available during this period. Local guidelines concerning the treatment of SARS-CoV-2 pneumonia, including the specific recommendations of the treatment with antibiotics, were developed by members of the infectious diseases, pharmacy, and ICU departments.…”

“…The appearance of an outbreak caused by a specific microorganism may be the cause of a marked increase in antimicrobial consumption. In the case of the Coronavirus Disease-19 (COVID-19) pandemic, an important impact on the DDD/100 bed-days of specific antibiotics could be expected [ 6 ]. Potential causes include an increase in hospital stay associated with this infection or the high rate of intensive care unit (ICU) admission, which in fact led to the collapse of beds for the care of critical patients.…”

“…Other studies have shown an increase in the consumption of antimicrobials during the first wave of the COVID-19 pandemic [ 6 , 15 , 16 , 17 ]. However, these studies either have not described the data according to the different molecules or have not performed a statistical analysis of the data.…”

Multidrug-Resistant Bacterial Infections in Geriatric Hospitalized Patients before and after the COVID-19 Outbreak: Results from a Retrospective Observational Study in Two Geriatric Wards

“…Intensive care unit studies in Italy demonstrated an increase in the rate of infections by Klebsiella carbapenemase-resistant, E. coli , and Enterococcus spp., but these studies considered both COVID-19 and no COVID-19 patients [ 24 , 25 ]. Conversely, in a Spanish study carried out in a tertiary hospital for 20 weeks before and during the COVID-19 spread, the mean incidence density of blood infections caused by MDR organisms remained stable, with a value of 0.36 ± 0.42 cases per 1000 occupied bed days in the COVID-19 period and 0.33 ± 0.28 bloodstream infections per 1000 occupied bed days in the period before the national lockdown [ 26 ]. Our findings are different due to the increased rate of bloodstream infection positive for Staphylococcus MDR.…”