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Elsafi SH, Almutairi SH, Alsulaimani MA, AlBahrani S, Al-Maqati TN, Alanazi WK, Alanazi MN, Alamri AA, Alkhathami MH, Alshammari RA, Alharbi NF, Al Naam YA. The Trend of Antibiotic Consumption After the COVID-19 Pandemic: Approach to Future Outbreaks. Infect Drug Resist 2024; 17:2227-2236. [PMID: 38854778 PMCID: PMC11162212 DOI: 10.2147/idr.s460148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024] Open
Abstract
Background Earlier reports suggested high rates of antibiotic utilization among COVID-19 patients despite the lack of direct evidence of their activity against viral pathogens. Different trends in antibiotic consumption during 2020 compared to 2019 have been reported. Purpose The objective of this study is to assess the impact of COVID-19 pandemic on antibiotic consumption in the presence of active Antibiotic Stewardship Program. Methods This study represented a five years assessment of the consumption of the commonly prescribed antibiotics measured as DDDs/100-Bed Days. We analyzed the data by using nonparametric Friedman and Friedman tests to compare the antibiotic consumption before and during the three subsequent waves of COVID-19. Results Antibiotic consumption through the DDDs/100-BD has shown reduction in the median of antibiotics consumption of most antibiotics during the period of COVID-19 as compared to the pre-COVID-19 period, which was significant for meropenem and ciprofloxacin, except colomycin that slightly increased. Significant reduction in the consumption of imipenem and meropenem during the second and third waves as compared to the pre-COVID period. Throughout the years, significant reductions were observed between 2018 and 2019 (p=<.001), 2018 and 2020 (p=0.008), and 2018 and 2022 (p=0.002). Conclusion The reduction in antibiotic consumption is attributed to the strong influence if the ASP and the reluctance of people to visit hospitals during the COVID-19 pandemic. Other related COVID-19 precautions such as physical distance, good hand hygiene, facemasks, that resulted in the prevention of secondary bacterial infections have contributed to the reduction in antibiotic utilization during the pandemic.
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Affiliation(s)
- Salah H Elsafi
- Clinical Laboratory Sciences. Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Saleh H Almutairi
- Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Mujahid A Alsulaimani
- Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Salma AlBahrani
- Infectious Disease Unit, Specialty Internal Medicine, King Fahhd Military Medical Complex, Dhahran Saudi Arabia; College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudia Arabia
| | - Thekra N Al-Maqati
- Clinical Laboratory Sciences. Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Wafa K Alanazi
- Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Mohammed N Alanazi
- Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Abdullah A Alamri
- Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Majed Hamoud Alkhathami
- Department of Support Services, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Rakkad A Alshammari
- Department of Support Services, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Naif F Alharbi
- Department of Support Services, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
| | - Yaser A Al Naam
- Clinical Laboratory Sciences. Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia
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Reffat N, Schwei RJ, Griffin M, Pop-Vicas A, Schulz LT, Pulia MS. A scoping review of bacterial resistance among inpatients amidst the COVID-19 pandemic. J Glob Antimicrob Resist 2024; 38:49-65. [PMID: 38789083 DOI: 10.1016/j.jgar.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic disrupted antimicrobial stewardship and infection prevention operations worldwide, raising concerns for an acceleration of antimicrobial resistance (AMR). Therefore, we aimed to define the scope of peer reviewed research comparing AMR in inpatient bacterial clinical cultures before and after the start of the COVID-19 pandemic. METHODS We conducted a scoping review and searched PubMed, Scopus, and Web of Science through 15 June 2023. Our inclusion criteria were: (1) English language, (2) primary evidence, (3) peer-reviewed, (4) clinical culture data from humans, (5) AMR data for at least one bacterial order/species, (6) inpatient setting, (7) use of statistical testing to evaluate AMR data before and during the COVID-19 pandemic. Reviewers extracted country, study design, type of analysis, study period, setting and population, number of positive cultures or isolates, culture type(s), method of AMR analysis, organisms, and AMR results. Study results were organised by organism and antibiotic class or resistance mechanism. AMR results are also summarised by individual study and across all studies. RESULTS In total, 4805 articles were identified with 55 papers meeting inclusion criteria. Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus were the most commonly studied organisms. There were 464 bacterial AMR results across all studies with 82 (18%) increase, 71 (15%) decrease, and 311 (67%) no change results. CONCLUSIONS The literature examining the impact of COVID-19 on AMR among inpatients is diverse with most results reflecting no change pre/post pandemic. Ongoing inquiry is needed into evolving patterns in AMR post COVID-19.
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Affiliation(s)
- Noora Reffat
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Rebecca J Schwei
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Meggie Griffin
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Aurora Pop-Vicas
- Department of Medicine-Division of Infectious Disease, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Lucas T Schulz
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA.
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Laffont-Lozes P, Larcher R, Salipante F, Leguelinel-Blache G, Dunyach-Remy C, Lavigne JP, Sotto A, Loubet P. Usefulness of dynamic regression time series models for studying the relationship between antimicrobial consumption and bacterial antimicrobial resistance in hospitals: a systematic review. Antimicrob Resist Infect Control 2023; 12:100. [PMID: 37697357 PMCID: PMC10496333 DOI: 10.1186/s13756-023-01302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUNG Antimicrobial resistance (AMR) is on the rise worldwide. Tools such as dynamic regression (DR) models can correlate antimicrobial consumption (AMC) with AMR and predict future trends to help implement antimicrobial stewardship programs (ASPs). MAIN BODY We carried out a systematic review of the literature up to 2023/05/31, searching in PubMed, ScienceDirect and Web of Science. We screened 641 articles and finally included 28 studies using a DR model to study the correlation between AMC and AMR at a hospital scale, published in English or French. Country, bacterial species, type of sampling, antimicrobials, study duration and correlations between AMC and AMR were collected. The use of β-lactams was correlated with cephalosporin resistance, especially in Pseudomonas aeruginosa and Enterobacterales. Carbapenem consumption was correlated with carbapenem resistance, particularly in Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii. Fluoroquinolone use was correlated with fluoroquinolone resistance in Gram-negative bacilli and methicillin resistance in Staphylococcus aureus. Multivariate DR models highlited that AMC explained from 19 to 96% of AMR variation, with a lag time between AMC and AMR variation of 2 to 4 months. Few studies have investigated the predictive capacity of DR models, which appear to be limited. CONCLUSION Despite their statistical robustness, DR models are not widely used. They confirmed the important role of fluoroquinolones, cephalosporins and carbapenems in the emergence of AMR. However, further studies are needed to assess their predictive capacity and usefulness for ASPs.
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Affiliation(s)
- Paul Laffont-Lozes
- Department of Pharmacy, Nimes University Hospital, Nimes, France
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
| | - Romaric Larcher
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France.
- PhyMedExp, INSERM U1046, CNRS, University of Montpellier, Montpellier, France.
- Service des Maladies Infectieuses et Tropicales, Hôpital Caremeau - CHU de Nimes, 1 Place Robert Debre, Nîmes, 30000, France.
| | - Florian Salipante
- Department of Biostatistics, Epidemiology, Public Health, and Innovation in Methodology (BESPIM), University of Montpellier, Nîmes University Hospital, Nimes, France
| | - Geraldine Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, Nimes, France
- Department of Biostatistics, Epidemiology, Public Health, and Innovation in Methodology (BESPIM), University of Montpellier, Nîmes University Hospital, Nimes, France
| | - Catherine Dunyach-Remy
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Jean-Philippe Lavigne
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Albert Sotto
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Paul Loubet
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
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Langford BJ, Soucy JPR, Leung V, So M, Kwan AT, Portnoff JS, Bertagnolio S, Raybardhan S, MacFadden DR, Daneman N. Antibiotic resistance associated with the COVID-19 pandemic: a systematic review and meta-analysis. Clin Microbiol Infect 2023; 29:302-309. [PMID: 36509377 PMCID: PMC9733301 DOI: 10.1016/j.cmi.2022.12.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND COVID-19 and antimicrobial resistance (AMR) are two intersecting global public health crises. OBJECTIVE We aimed to describe the impact of the COVID-19 pandemic on AMR across health care settings. DATA SOURCE A search was conducted in December 2021 in WHO COVID-19 Research Database with forward citation searching up to June 2022. STUDY ELIGIBILITY Studies evaluating the impact of COVID-19 on AMR in any population were included and influencing factors were extracted. Reporting of enhanced infection prevention and control and/or antimicrobial stewardship programs was noted. METHODS Pooling was done separately for Gram-negative and Gram-positive organisms. Random-effects meta-analysis was performed. RESULTS Of 6036 studies screened, 28 were included and 23 provided sufficient data for meta-analysis. The majority of studies focused on hospital settings (n = 25, 89%). The COVID-19 pandemic was not associated with a change in the incidence density (incidence rate ratio 0.99, 95% CI: 0.67-1.47) or proportion (risk ratio 0.91, 95% CI: 0.55-1.49) of methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci cases. A non-statistically significant increase was noted for resistant Gram-negative organisms (i.e. extended-spectrum beta-lactamase, carbapenem-resistant Enterobacterales, carbapenem or multi-drug resistant or carbapenem-resistant Pseudomonas aeruginosa or Acinetobacter baumannii, incidence rate ratio 1.64, 95% CI: 0.92-2.92; risk ratio 1.08, 95% CI: 0.91-1.29). The absence of reported enhanced infection prevention and control and/or antimicrobial stewardship programs initiatives was associated with an increase in gram-negative AMR (risk ratio 1.11, 95% CI: 1.03-1.20). However, a test for subgroup differences showed no statistically significant difference between the presence and absence of these initiatives (p 0.40). CONCLUSION The COVID-19 pandemic may have hastened the emergence and transmission of AMR, particularly for Gram-negative organisms in hospital settings. But there is considerable heterogeneity in both the AMR metrics used and the rate of resistance reported across studies. These findings reinforce the need for strengthened infection prevention, antimicrobial stewardship, and AMR surveillance in the context of the COVID-19 pandemic.
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Affiliation(s)
- Bradley J. Langford
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Corresponding author. Bradley J. Langford, Public Health Ontario, Health Protection, 480 University Avenue, Toronto, Ontario M5G 1V2, Canada
| | - Jean-Paul R. Soucy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Leung
- Public Health Ontario, Toronto, Ontario, Canada,Toronto East Health Network, Toronto, Ontario, Canada
| | - Miranda So
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Angela T.H. Kwan
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacob S. Portnoff
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Silvia Bertagnolio
- Department of Surveillance, Prevention and Control, Division of Antimicrobial Resistance, World Health Organization, Geneva, Switzerland
| | | | - Derek R. MacFadden
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Ioannou P, Maraki S, Koumaki D, Manios GA, Koumaki V, Kassotakis D, Zacharopoulos GV, Kofteridis DP, Manios A, de Bree E. A Six-Year Retrospective Study of Microbiological Characteristics and Antimicrobial Resistance in Specimens from a Tertiary Hospital’s Surgical Ward. Antibiotics (Basel) 2023; 12:antibiotics12030490. [PMID: 36978357 PMCID: PMC10044204 DOI: 10.3390/antibiotics12030490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Surgery has revolutionized the practice of medicine by allowing the treatment of conditions amenable to conservative medical management with some of them pathophysiologically involving the prevalence of pathogenic microorganisms. On the other hand, infections such as surgical site infections or urinary tract infections may complicate patients hospitalized in surgical wards leading to considerable morbidity, mortality, and increased healthcare-associated costs. The aim of this study was to present the microbiological characteristics and antimicrobial resistance of all isolates identified in microbiological specimens from a surgical ward of a tertiary hospital in Greece during a six-year period. Only specimens that yielded at least one microorganism were included in the analysis. In total, 1459 strains in 789 positive cultures were isolated. The most common sample sent to the microbiology department was pus from surgical wounds. The most common pathogens among all 1459 strains isolated were Enterobacterales at 33% (n = 482), however, the most common genus was Enterococcus at 22.3% (n = 326). Antimicrobial resistance against third-generation cephalosporins was 23% (n = 111/482) among Enterobacterales, while, the rate of vancomycin-resistant enterococci (VRE) was 18.5% (n = 60/324) among Enterococcus species and was increasing in the last years of the study. Antimicrobial resistance of Acinetobacter baumannii to carbapenems was 68.8% (n = 11/16), which was lower than the corresponding rate in other wards in Greece. The antimicrobial resistance rates noted herein raise questions regarding the appropriateness of currently suggested antimicrobials in guidelines and imply that a revision could be required. Practicing clinicians should always be aware of local microbiological data that allow the selection of appropriate antimicrobials for the management of infections. Finally, the increasing rates of VRE noted herein mandate further actions from the point of infection control and antimicrobial stewardship.
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Affiliation(s)
- Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
- Correspondence:
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Dimitra Koumaki
- Department of Dermatology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgios A. Manios
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 38221 Lamia, Greece
| | - Vasiliki Koumaki
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Dimitrios Kassotakis
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | | | - Diamantis P. Kofteridis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Andreas Manios
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Eelco de Bree
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
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