The Impact of the SARS-Cov2 Pandemic on a Persuasive Educational Antimicrobial Stewardship Program in a University Hospital in Southern Italy: A Pre-Post Study

Abstract

Objectives: We evaluated the effect of the pandemic on the disruption of a persuasive educational antimicrobial stewardship program (ASP) conducted in a university hospital in southern Italy. Methods: In March 2020, the ASP, which began in January 2017 and was carried out at different times in 10 wards, was stopped due to the COVID-19 pandemic. We conducted an observational study with interrupted time series analysis to compare the antibiotic consumption and costs, average length of hospital stay and in-hospital mortality between 12 months before and 9 months after the interruption. Results: Four medical, four surgical wards and two ICUs were included in the study, for a total of 35,921 patient days. Among the medical wards we observed after the interruption a significant increase in fluoroquinolone use, with a change in trend (CT) of 0.996, p = 0.027. In the surgical wards, we observed a significant increase in the overall consumption, with a change in level (CL) of 24.4, p = 0.005, and in the use of third and fourth generation cephalosporins (CL 4.7, p = 0.003). In two ICUs, we observed a significant increase in piperacillin/tazobactam and fluoroquinolone consumption (CT 9.28, p = 0.019, and 2.4, p = 0.047). In the wards with a duration of ASP less than 30 months, we observed a significant increase in antibiotic consumption in the use of piperacillin/tazobactam and fluoroquinolones (CT 12.9, p = 0.022: 4.12, p = 0.029; 1.004, p = 0.011). Conclusions: The interruption of ASP during COVID-19 led to an increase in the consumption of broad-spectrum antibiotics, particularly in surgical wards and in those with a duration of ASP less than 30 months.

Long-Term Impact of the COVID-19 Pandemic on In-Hospital Antibiotic Consumption and Antibiotic Resistance: A Time Series Analysis (2015–2021)

“…Indeed, in our hospital, a widespread AS program based on prospective audits and feedback (PAF) that was implemented in 2015 and re-started after the first wave could have positively influenced the rapid restoration of appropriate prescriptions. This assumption is also supported by other colleagues who analyzed the effect of the pandemic on a persuasive educational antimicrobial stewardship program [ 36 ].…”

What is the impact of SARS-CoV-2 pandemic on antimicrobial stewardship programs (ASPs)? The results of a survey among a regional network of infectious disease centres

“…First, the fight against SARS-CoV-2 absorbed most of the economic resources of the health care system and, consequently, ASPs, as well as other non-primary health services, were inevitably sacrificed. Moreover, other factors related to COVID-19 management were potentially linked to disruption of antimicrobial surveillance and consequent increased use of antimicrobials and MDRO outbreaks, such as the focus of healthcare workers on self-protection, hospital overcrowding, low health care workers (HCW):patient ratio, personal protective equipment shortage etc [ 4 , 5 , 10 ].…”

“…4 LIUC Cattaneo University, Castellanza, VA, Italy. 5 Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Degli Studi di Milano, Milan, Italy. 6 Infectious Diseases Unit, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.…”

“…Although it might be too early to estimate the consequences of the pandemic on AMR progression, early studies showed that the interruption of ASPs led to an overall increase in broad spectrum antibiotics use and multidrug resistant (MDR) healthcare-associated infections (HAIs) incidence [ 3 , 5 ]. Conversely, in settings where strong ASPs were maintained, antibiotic consumption decreased during the pandemic [ 6 ].…”

“…In a survey conducted in the UK, more than 60% of participating centres reported that COVID-19 had a negative impact on routine AMS activities with a decrease in stewardship rounds, multidisciplinary meetings and point prevalent surveys [4]. Although it might be too early to estimate the consequences of the pandemic on AMR progression, early studies showed that the interruption of ASPs led to an overall increase in broad spectrum antibiotics use and multidrug resistant (MDR) healthcare-associated infections (HAIs) incidence [3,5]. Conversely, in settings where strong ASPs were maintained, antibiotic consumption decreased during the pandemic [6].…”