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Foxlee ND, Taleo SA, Mathias A, Townell N, McIver L, Lau CL. The Impact of COVID-19 on Knowledge, Beliefs, and Practices of Ni-Vanuatu Health Workers Regarding Antibiotic Prescribing and Antibiotic Resistance, 2018 and 2022: A Mixed Methods Study. Trop Med Infect Dis 2023; 8:477. [PMID: 37888605 PMCID: PMC10611053 DOI: 10.3390/tropicalmed8100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Antimicrobial resistance (AMR) is included in the ten most urgent global public health threats. Global evidence suggests that antibiotics were over prescribed during the early waves of the COVID-19 pandemic, particularly in low- and middle-income countries. Inappropriate use of antibiotics drives the emergence and spread of antibiotic resistance. This study aimed to examine the impact of COVID-19 on Ni-Vanuatu health worker knowledge, beliefs, and practices (KBP) regarding antibiotic prescribing and awareness of antibacterial AMR. A mixed methods study was conducted using questionnaires and in-depth interviews in 2018 and 2022. A total of 49 respondents completed both baseline (2018) and follow-up (2022) questionnaires. Knowledge scores about prescribing improved between surveys, although health workers were less confident about some prescribing activities. Respondents identified barriers to optimal hand hygiene performance. More than three-quarters of respondents reported that COVID-19 influenced their prescribing practice and heightened their awareness of ABR: "more careful", "more aware", "stricter", and "need more community awareness". Recommendations include providing ongoing continuing professional development to improve knowledge, enhance skills, and maintain prescribing competency; formalising antibiotic stewardship and infection, prevention, and control (IPC) programmes to optimise prescribing and IPC practices; and raising community awareness about ABR to support more effective use of medications.
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Affiliation(s)
- Nicola D. Foxlee
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 2600, Australia
| | - Siti Aishah Taleo
- Dispensary, Vila Central Hospital, Ministry of Health, Private Mail Bag, Port Vila 9009, Vanuatu
| | - Agnes Mathias
- Curative Services, Ministry of Health, Private Mail Bag, Port Vila 9009, Vanuatu
| | - Nicola Townell
- Pacific Region Infectious Diseases Association, Kenmore Hills, QLD 4069, Australia
| | | | - Colleen L. Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia;
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Geng Y, Li F, Chen C, Liu Z, Ma X, Su X, Meng H, Lu W, Wang X, Pan D, Liang P. Increased Incidence and Risk Factors of Infections by Extended-Spectrum β-Lactamase-Producing Enterobacterales During the COVID-19 Pandemic: A Retrospective Case-Control Study. Infect Drug Resist 2023; 16:4707-4716. [PMID: 37492798 PMCID: PMC10364815 DOI: 10.2147/idr.s421240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023] Open
Abstract
Purpose To investigate changes in the incidence of infections by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) and analyzed whether there was an association between endogenous changes in the organism due to COVID-19 infection and the infections by ESBL-E. Patients and Methods The study was a single-center retrospective case-control design. A total of 107 patients infected by ESBL-E during the COVID-19 pandemic were selected as the case group, while 214 uninfected patients selected by 1:2 propensity score matching (PSM) acted as the control group. Univariate analysis, LASSO logistic regression, and multivariate logistic regression were used to determine the risk factors for ESBL-E infection. An interrupted time series was used to analyze the changes in the incidence of ESBL-E infections in hospitalized patients during the COVID-19 pandemic. Results The incidence of infection with ESBL-E showed a significant increase during COVID-19 (3.42 vs 4.92 per 1000 patients, p = 0.003). The incidence of ESBL-E infections increased at an average rate of 0.45 per 1000 patients per week compared to the pre-pandemic period (p = 0.022). Multivariate logistic regression analysis showed that a length of hospitalization ≥ 15 days (OR: 2.98 (1.07-8.28), chronic kidney disease (OR: 4.25 (1.32-13.70), white blood cell (WBC) > 9.5×10^9/L (OR: 3.04 (1.54-6.01), use of hormonal drugs (OR: 2.38 (1.04-5.43), antibacterial drug use 1 type (OR: 5.38 (2.04-14.21), antibacterial drug use 2 types (OR: 23.05 (6.71-79.25) and antibacterial drug use ≥ 3 types (OR: 88.35 (8.55-912.63) were independent risk factors for infection with ESBL-E, while chronic obstructive pulmonary disease (COPD) was a protective factor (OR: 0.14 (0.03-0.66). COVID-19 was not an independent risk factor for infection by ESBL-E. Conclusion During the COVID-19 pandemic, the incidence of infections by ESBL-E increased significantly. Increased exposure to traditional risk factors were the main reasons, however, COVID-19 was not an independent risk factor for ESBL-E infection.
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Affiliation(s)
- Yuhui Geng
- School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Furong Li
- Department of Clinical Laboratory, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China
| | - Chen Chen
- Department of Public Health, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China
| | - Zhuo Liu
- School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xiaojuan Ma
- School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xinya Su
- School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Hua Meng
- School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Wenwen Lu
- School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xingtian Wang
- School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Dongfeng Pan
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China
| | - Peifeng Liang
- Department of Medical Records and Statistics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China
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Recommendations and guidelines for the diagnosis and management of Coronavirus Disease-19 (COVID-19) associated bacterial and fungal infections in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:207-235. [PMID: 36586743 PMCID: PMC9767873 DOI: 10.1016/j.jmii.2022.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Coronavirus disease-19 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2 that has rapidly evolved into a pandemic to cause over 600 million infections and more than 6.6 million deaths up to Nov 25, 2022. COVID-19 carries a high mortality rate in severe cases. Co-infections and secondary infections with other micro-organisms, such as bacterial and fungus, further increases the mortality and complicates the diagnosis and management of COVID-19. The current guideline provides guidance to physicians for the management and treatment of patients with COVID-19 associated bacterial and fungal infections, including COVID-19 associated bacterial infections (CABI), pulmonary aspergillosis (CAPA), candidiasis (CAC) and mucormycosis (CAM). Recommendations were drafted by the 7th Guidelines Recommendations for Evidence-based Antimicrobial agents use Taiwan (GREAT) working group after review of the current evidence, using the grading of recommendations assessment, development, and evaluation (GRADE) methodology. A nationwide expert panel reviewed the recommendations in March 2022, and the guideline was endorsed by the Infectious Diseases Society of Taiwan (IDST). This guideline includes the epidemiology, diagnostic methods and treatment recommendations for COVID-19 associated infections. The aim of this guideline is to provide guidance to physicians who are involved in the medical care for patients with COVID-19 during the ongoing COVID-19 pandemic.
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Aldardeer NF, Shukairi ANAL, Nasser ME, Al Musawa M, Kalkatawi BS, Alsahli RM, Ramdan AME, Qushmaq I, Aldhaeefi M. Continuation Versus De-escalation of Broad-Spectrum Antibiotic Therapy in Critically Ill COVID-19 Patients. DR. SULAIMAN AL HABIB MEDICAL JOURNAL 2023. [PMCID: PMC9972303 DOI: 10.1007/s44229-023-00027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Background Antibiotic de-escalation (ADE) is a stewardship initiative that aims to reduce exposure to antimicrobials, thus limiting their unwanted effect, including antimicrobial resistance. Our study aims to describe the impact of ADE compared with the continuation of therapy on the outcome of critically ill coronavirus disease 2019 (COVID-19) patients. Material and Methods A single-center retrospective study included critically ill COVID-19 adult patients admitted between January 1, 2019 and August 31, 2021, and started on broad-spectrum antibiotics. The primary outcome was intensive care unit (ICU) mortality. In addition, other clinical outcomes were evaluated, including ICU readmissions, length of stay, and superinfection. Results The study included 73 patients with a mean age of 61.0 ± 19.4, and ADE was performed in 10 (13.6%) of these. In the ADE group, 8/10 (80%) cultures were positive. ICU mortality was not statistically different between ADE and continuation of therapy groups (60 vs. 41.3%, respectively, P = 0.317). Superinfection occurred in 4 (5.4%) patients. Hospital mortality, length of stay, and ICU readmission rates did not differ significantly between groups. Conclusion De-escalation of broad-spectrum antibiotics in critically ill covid-19 patients was not associated with higher mortality. A larger cohort is needed to confirm these findings. Supplementary Information The online version contains supplementary material available at 10.1007/s44229-023-00027-0.
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Affiliation(s)
| | - Abeer Nizar A. L. Shukairi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia ,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohannad E. Nasser
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Mohammad Al Musawa
- Medication Safety/Clinical Support Pharmacy, King Faisal Specialist Hospital and Research Centre (Gen. Org.), Jeddah, Saudi Arabia
| | | | | | | | - Ismael Qushmaq
- Section of Critical Care Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Center (Gen. Org.), Jeddah, Saudi Arabia
| | - Mohammed Aldhaeefi
- Department of Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, DC, USA
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Peterson JM, White K, Muehling E, Ebert SC, Lambi L, Thieman C, Peterson N, Deuel K, Bushman AM, Kumar S, Best LA, Rosa R. Trends in antibiotic use before and during the coronavirus disease 2019 (COVID-19) pandemic across an integrated health system with different antimicrobial stewardship program models trends in antibiotic use by ASP model. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e55. [PMID: 36483401 PMCID: PMC9726599 DOI: 10.1017/ash.2022.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 06/17/2023]
Abstract
Changes in antimicrobial use during the pandemic in relation to long-term trends in utilization among different antimicrobial stewardship program models have not been fully characterized. We analyzed data from an integrated health system using joinpoint regression and found temporal fluctuations in prescribing as well as continuation of existing trends.
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Affiliation(s)
| | - Kristina White
- Department of Pharmacy, UnityPoint Health–Peoria, Peoria, Illinois
| | - Emily Muehling
- Department of Pharmacy, System Clinical Services, UnityPoint Health–Des Moines, Des Moines, Iowa
| | - Steven C. Ebert
- Department of Pharmacy, UnityPoint Health–Meriter, Madison, Wisconsin
| | - Lisa Lambi
- Department of Pharmacy, UnityPoint Health–Cedar Rapids, Cedar Rapids, Iowa
| | - Corey Thieman
- Department of Pharmacy, UnityPoint Health–Sioux City, Sioux City, Iowa
| | - Nathan Peterson
- Department of Pharmacy, UnityPoint Health–Quad Cities, Bettendorf, Iowa
| | - Kia Deuel
- Department of Infection Prevention, UnityPoint Health–Fort Dodge, Fort Dodge, Iowa
| | - Amanda M. Bushman
- Department of Pharmacy, UnityPoint Health–Des Moines, Des Moines, Iowa
| | - Sudhir Kumar
- Infectious Diseases Service, UnityPoint Health–Des Moines, Des Moines, Iowa
- Department of Internal Medicine, University of Iowa–Des Moines Campus, Des Moines, Iowa
| | - Leyla A. Best
- Infectious Diseases Service, UnityPoint Health–Des Moines, Des Moines, Iowa
- Department of Internal Medicine, University of Iowa–Des Moines Campus, Des Moines, Iowa
| | - Rossana Rosa
- Infectious Diseases Service, UnityPoint Health–Des Moines, Des Moines, Iowa
- Department of Internal Medicine, University of Iowa–Des Moines Campus, Des Moines, Iowa
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6
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Gottesman BS, Low M, Netzer D, Almog R, Chowers M. Community antibiotic prescriptions during COVID-19 era: A population-based cohort study among adults. Clin Microbiol Infect 2022; 28:1134-1139. [PMID: 35283310 PMCID: PMC8908574 DOI: 10.1016/j.cmi.2022.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 12/25/2022]
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Chitungo I, Dzinamarira T, Nyazika TK, Herrera H, Musuka G, Murewanhema G. Inappropriate Antibiotic Use in Zimbabwe in the COVID-19 Era: A Perfect Recipe for Antimicrobial Resistance. Antibiotics (Basel) 2022; 11:antibiotics11020244. [PMID: 35203846 PMCID: PMC8868384 DOI: 10.3390/antibiotics11020244] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/08/2023] Open
Abstract
The global COVID-19 pandemic has resulted in an upsurge in antimicrobial use. The increase in use is multifactorial, and is particularly related to the empirical treatment of SARS-CoV-2 and suspected coinfections with antimicrobials and the limited quality of diagnostics to differentiate viral and bacterial pneumonia. The lack of clear clinical guidelines across a wide range of settings, and the inadequacy of public health sectors in many countries, have contributed to this pattern. The increased use of antimicrobials has the potential to increase incidences of antimicrobial resistance, especially in low-resource countries such as Zimbabwe already grappling with multidrug-resistant micro-organism strains. By adopting the antimicrobial stewardship principles of the correct prescription and optimised use of antimicrobials, as well as diagnostic stewardship, revamping regulatory oversight of antimicrobial surveillance may help limit the occurrence of antimicrobial resistance during this pandemic.
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Affiliation(s)
- Itai Chitungo
- Chemical Pathology Unit, Department of Medical Laboratory Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe;
| | - Tafadzwa Dzinamarira
- School of Health Systems & Public Health, University of Pretoria, Pretoria 0002, South Africa;
- ICAP at Columbia University, Harare, Zimbabwe
- Correspondence:
| | - Tinashe K. Nyazika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2UP, UK;
| | - Godfrey Musuka
- School of Health Systems & Public Health, University of Pretoria, Pretoria 0002, South Africa;
| | - Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe;
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8
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Van Laethem J, Wuyts S, Van Laere S, Koulalis J, Colman M, Moretti M, Seyler L, De Waele E, Pierard D, Lacor P, Allard SD. Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers. Intern Emerg Med 2022; 17:141-151. [PMID: 34185257 PMCID: PMC8239323 DOI: 10.1007/s11739-021-02790-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/05/2021] [Indexed: 11/24/2022]
Abstract
This study aims to quantify antibiotic consumption for suspected respiratory tract superinfections in COVID-19 patients, while investigating the associated drivers of antibiotic prescribing in light of the current signs of antibiotic overuse. Adult patients with a positive COVID-19 diagnosis admitted to a Belgian 721-bed university hospital were analyzed retrospectively (March 11th-May 4th, 2020), excluding short-term admissions (< 24 h). Antibiotic prescriptions were analyzed and quantified, using Defined Daily Doses (DDD) per admission and per 100 bed days. Possible drivers of antibiotic prescribing were identified by means of mixed effects logistic modelling analysis with backwards selection. Of all included admissions (n = 429), 39% (n = 171) were prescribed antibiotics for (presumed) respiratory tract superinfection (3.6 DDD/admission; 31.5 DDD/100 bed days). Consumption of beta-lactamase inhibitor-penicillin combinations was the highest (2.55 DDD/admission; 23.3 DDD/100 bed days). Four drivers were identified: fever on admission (OR 2.97; 95% CI 1.42-6.22), lower SpO2/FiO2 ratio on admission (OR 0.96; 95% CI 0.92-0.99), underlying pulmonary disease (OR 3.04; 95% CI 1.12-8.27) and longer hospital stay (OR 1.09; 95% CI 1.03-1.16). We present detailed quantitative antibiotic data for presumed respiratory tract superinfections in hospitalized COVID-19 patients. In addition to knowledge on antibiotic consumption, we hope antimicrobial stewardship programs will be able to use the drivers identified in this study to optimize their interventions in COVID-19 wards.
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Affiliation(s)
- J Van Laethem
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium.
| | - S Wuyts
- Hospital Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Research Group Clinical Pharmacology and Pharmacotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Van Laere
- Interfaculty Centre Data Processing and Statistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - J Koulalis
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - M Colman
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - M Moretti
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - L Seyler
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - E De Waele
- Intensive Care Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - D Pierard
- Microbiology Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - P Lacor
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - S D Allard
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
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Rothe K, Spinner CD, Panning M, Pletz MW, Rohde G, Rupp J, Witzenrath M, Erber J, Eberhardt F, Essig A, Schneider J. Evaluation of a multiplex PCR screening approach to identify community-acquired bacterial co-infections in COVID-19: a multicenter prospective cohort study of the German competence network of community-acquired pneumonia (CAPNETZ). Infection 2021; 49:1299-1306. [PMID: 34687426 PMCID: PMC8536912 DOI: 10.1007/s15010-021-01720-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023]
Abstract
Purpose Thorough knowledge of the nature and frequency of co-infections is essential to optimize treatment strategies and risk assessment in cases of coronavirus disease 2019 (COVID-19). This study aimed to evaluate the multiplex polymerase chain reaction (PCR) screening approach for community-acquired bacterial pathogens (CABPs) at hospital admission, which could facilitate identification of bacterial co-infections in hospitalized COVID-19 patients. Methods Clinical data and biomaterials from 200 hospitalized COVID-19 patients from the observational cohort of the Competence Network for community-acquired pneumonia (CAPNETZ) prospectively recruited between March 17, 2020, and March 12, 2021 in 12 centers in Germany and Switzerland, were included in this study. Nasopharyngeal swab samples were analyzed on hospital admission using multiplex real-time reverse transcription (RT)-PCR for a broad range of CABPs. Results In total of 200 patients Staphylococcus aureus (27.0%), Haemophilus influenzae (13.5%), Streptococcus pneumoniae (5.5%), Moraxella catarrhalis (2.5%), and Legionella pneumophila (1.5%) were the most frequently detected bacterial pathogens. PCR detection of bacterial pathogens correlated with purulent sputum, and showed no correlation with ICU admission, mortality, and inflammation markers. Although patients who received antimicrobial treatment were more often admitted to the ICU and had a higher mortality rate, PCR pathogen detection was not significantly related to antimicrobial treatment. Conclusion General CABP screening using multiplex PCR with nasopharyngeal swabs may not facilitate prediction or identification of bacterial co-infections in the early phase of COVID-19-related hospitalization. Most patients with positive PCR results appear to be colonized rather than infected at that time, questioning the value of routine antibiotic treatment on admission in COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01720-8.
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Affiliation(s)
- Kathrin Rothe
- School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcus Panning
- Faculty of Medicine, Institute of Virology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- CAPNETZ Stiftung, Hannover, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
| | - Martin Witzenrath
- Division of Pulmonary Inflammation, Department of Infectious Diseases and Pulmonary Medicine, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
| | - Johanna Erber
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | | | - Andreas Essig
- Department of Medical Microbiology and Hygiene, University of Ulm, Ulm, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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10
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Mamun AA, Saatchi A, Xie M, Lishman H, Blondel-Hill E, Marra F, Patrick DM. Community Antibiotic Use at the Population Level During the SARS-CoV-2 Pandemic in British Columbia, Canada. Open Forum Infect Dis 2021; 8:ofab185. [PMID: 34183981 PMCID: PMC8083279 DOI: 10.1093/ofid/ofab185] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022] Open
Abstract
Background The objective of this study was to examine the aggregate rates of antibiotic use at the population level and compare these rates over time against historical averages to identify the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resulting control measures on community prescribing. Methods We collected antibiotic prescriptions and physician office visits from January 1, 2016, to July 21, 2020. We calculated monthly prescription rates stratified by sex, age group, profession, diagnosis type, and antibiotic class. We looked at monthly prescription rate as a moving average over time. Using the interrupted time series analysis method, we estimated the changes in prescription rates after March 2020. Results The moving average of overall monthly prescription rates during January–June 2020 was below the minimum of the historical years’ moving averages (2016–2019). We observed a >30% reduction in overall monthly prescription rates in April, May, and July of 2020 compared with the same months of 2019. We observed that overall monthly prescription rates experienced a significant level change of –12.79 (P < .001) during the coronavirus disease 2019 pandemic after March 2020, with the greatest level change being –18.02 among children 1–4 years of age (P < .001). We estimated an average –5.94 (P < .001) change in respiratory tract infection (RTI)–associated monthly prescription rates after March 2020. Overall prescription rates comparing January–July 2019 and their 2020 counterparts showed a decrease in monthly prescribing ranging from –1 to –5 for amoxicillin, amoxicillin and enzyme inhibitors, azithromycin, clarithromycin, and sulfamethoxazole. Conclusions In British Columbia, Canada, overall and RTI-specific monthly antibiotic prescription rates declined significantly during April–July 2020 compared with the same months in prepandemic years.
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Affiliation(s)
- Abdullah A Mamun
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Ariana Saatchi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Max Xie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hannah Lishman
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Patrick
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Martinez-Guerra BA, Gonzalez-Lara MF, de-Leon-Cividanes NA, Tamez-Torres KM, Roman-Montes CM, Rajme-Lopez S, Villalobos-Zapata GI, Lopez-Garcia NI, Martínez-Gamboa A, Sifuentes-Osornio J, Ortiz-Brizuela E, Ochoa-Hein E, Galindo-Fraga A, Bobadilla-del-Valle M, Ponce-de-León A. Antimicrobial Resistance Patterns and Antibiotic Use during Hospital Conversion in the COVID-19 Pandemic. Antibiotics (Basel) 2021; 10:antibiotics10020182. [PMID: 33670316 PMCID: PMC7917840 DOI: 10.3390/antibiotics10020182] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe empirical antimicrobial prescription on admission in patients with severe COVID-19, the prevalence of Hospital-Acquired Infections, and the susceptibility patterns of the causing organisms. METHODS In this prospective cohort study in a tertiary care center in Mexico City, we included consecutive patients admitted with severe COVID-19 between March 20th and June 10th and evaluated empirical antimicrobial prescription and the occurrence of HAI. RESULTS 794 patients with severe COVID-19 were admitted during the study period. Empiric antibiotic treatment was started in 92% of patients (731/794); the most frequent regimes were amoxicillin-clavulanate plus atypical coverage in 341 (46.6%) and ceftriaxone plus atypical coverage in 213 (29.1%). We identified 110 HAI episodes in 74/656 patients (11.3%). Ventilator-associated pneumonia (VAP) was the most frequent HAI, in 56/110 (50.9%), followed by bloodstream infections (BSI), in 32/110 (29.1%). The most frequent cause of VAP were Enterobacteriaceae in 48/69 (69.6%), followed by non-fermenter gram-negative bacilli in 18/69 (26.1%). The most frequent cause of BSI was coagulase negative staphylococci, in 14/35 (40.0%), followed by Enterobacter complex in 7/35 (20%). Death occurred in 30/74 (40.5%) patients with one or more HAI episodes and in 193/584 (33.0%) patients without any HAI episode (p < 0.05). CONCLUSION A high frequency of empiric antibiotic treatment in patients admitted with COVID-19 was seen. VAP and BSI were the most frequent hospital-acquired infections, due to Enterobacteriaceae and coagulase negative staphylococci, respectively.
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Affiliation(s)
- Bernardo A. Martinez-Guerra
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (B.A.M.-G.); (N.A.d.-L.-C.); (C.M.R.-M.); (S.R.-L.); (E.O.-B.)
| | - Maria F. Gonzalez-Lara
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (M.F.G.-L.); (K.M.T.-T.); (G.I.V.-Z.); (N.I.L.-G.); (A.M.-G.); (M.B.-d.-V.)
| | - Nereyda A. de-Leon-Cividanes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (B.A.M.-G.); (N.A.d.-L.-C.); (C.M.R.-M.); (S.R.-L.); (E.O.-B.)
| | - Karla M. Tamez-Torres
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (M.F.G.-L.); (K.M.T.-T.); (G.I.V.-Z.); (N.I.L.-G.); (A.M.-G.); (M.B.-d.-V.)
| | - Carla M. Roman-Montes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (B.A.M.-G.); (N.A.d.-L.-C.); (C.M.R.-M.); (S.R.-L.); (E.O.-B.)
| | - Sandra Rajme-Lopez
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (B.A.M.-G.); (N.A.d.-L.-C.); (C.M.R.-M.); (S.R.-L.); (E.O.-B.)
| | - G. Ivonne Villalobos-Zapata
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (M.F.G.-L.); (K.M.T.-T.); (G.I.V.-Z.); (N.I.L.-G.); (A.M.-G.); (M.B.-d.-V.)
| | - Norma I. Lopez-Garcia
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (M.F.G.-L.); (K.M.T.-T.); (G.I.V.-Z.); (N.I.L.-G.); (A.M.-G.); (M.B.-d.-V.)
| | - Areli Martínez-Gamboa
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (M.F.G.-L.); (K.M.T.-T.); (G.I.V.-Z.); (N.I.L.-G.); (A.M.-G.); (M.B.-d.-V.)
| | - Jose Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico;
| | - Edgar Ortiz-Brizuela
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (B.A.M.-G.); (N.A.d.-L.-C.); (C.M.R.-M.); (S.R.-L.); (E.O.-B.)
| | - Eric Ochoa-Hein
- Infection Control and Hospital Epidemiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (E.O.-H.); (A.G.-F.)
| | - Arturo Galindo-Fraga
- Infection Control and Hospital Epidemiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (E.O.-H.); (A.G.-F.)
| | - Miriam Bobadilla-del-Valle
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (M.F.G.-L.); (K.M.T.-T.); (G.I.V.-Z.); (N.I.L.-G.); (A.M.-G.); (M.B.-d.-V.)
| | - Alfredo Ponce-de-León
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico; (B.A.M.-G.); (N.A.d.-L.-C.); (C.M.R.-M.); (S.R.-L.); (E.O.-B.)
- Correspondence: ; Tel.: +52-55-5487-0900 (ext. 2421)
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12
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Rothe K, Lahmer T, Rasch S, Schneider J, Spinner CD, Wallnöfer F, Wurst M, Schmid RM, Waschulzik B, Fuest K, Kriescher S, Schneider G, Busch DH, Feihl S, Heim M. Dexamethasone therapy and rates of secondary pulmonary and bloodstream infections in critically ill COVID-19 patients. Multidiscip Respir Med 2021; 16:793. [PMID: 34760275 PMCID: PMC8567088 DOI: 10.4081/mrm.2021.793] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has become a pandemic. Bacterial superinfections seem to be associated with higher mortality in COVID-19 patients in intensive care units (ICUs). However, details on the prevalence and species distribution of secondary infections are limited. Moreover, the increasing use of dexamethasone may pose an additional risk of superinfections. METHODS We performed a single-center retrospective study of the clinical and microbiological characteristics of 154 COVID-19 patients admitted to the ICU between March 2020 and January 2021, focusing on bacterial infections, use of antimicrobial agents and dexamethasone therapy. RESULTS The median age was 68 years; 67.5% of the patients were men. Critically ill COVID-19 patients were treated with dexamethasone since July 2020 (second wave), which was not common during the first wave of the pandemic. In the dexamethasone group (n=90, 58.4%), respiratory pathogens were detected more frequently, as were multidrugresistant pathogens. The number of patients with polymicrobial detection of respiratory pathogens was significantly increased (p=0.013). The most frequently detected species were Enterobacterales, Staphylococcus aureus, and Aspergillus fumigatus. The rates of bloodstream infections did not differ between the groups. The use of dexamethasone in ICU COVID-19 patients was associated with higher rates of respiratory infectious complications. CONCLUSIONS Secondary infections are present in a substantial fraction of critically ill COVID-19 patients. Respiratory pathogens were detectable in the majority of COVID-19 ICU patients. The use of dexamethasone poses a potential risk of secondary pulmonary infections. Infectious complications in patients with dexamethasone therapy could be associated with worse outcomes.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich
| | - Tobias Lahmer
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich
| | - Sebastian Rasch
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich
| | - Jochen Schneider
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich
| | - Christoph D. Spinner
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich
- German Center for Infection Research (DZIF), Partner Site Munich, Munich
| | - Fabian Wallnöfer
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich
| | - Milena Wurst
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich
| | - Roland M. Schmid
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich
| | - Birgit Waschulzik
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, School of Medicine, Munich
| | - Kristina Fuest
- Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
| | - Silja Kriescher
- Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
| | - Gerhard Schneider
- Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
| | - Dirk H. Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich
- German Center for Infection Research (DZIF), Partner Site Munich, Munich
| | - Susanne Feihl
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich
| | - Markus Heim
- Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
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13
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Fernández-Urrusuno R, Meseguer Barros CM, Anaya-Ordóñez S, Borrego Izquierdo Y, Lallana-Álvarez MJ, Madridejos R, Tejón EM, Sánchez RP, Pérez Rodríguez O, García Gil M, Escudero Vilaplana B, Riádigos GMS, López-Fando MSP, Olmo Quintana V, Pina Gadea MB, García Alvarez A, Martorell MLS, Jiménez Arce JI, Aguilella Vizcaíno R, Pérez Martín J, Alzueta Isturiz N. Patients receiving a high burden of antibiotics in the community in Spain: a cross-sectional study. Pharmacol Res Perspect 2020; 9:e00692. [PMID: 33340264 PMCID: PMC7749514 DOI: 10.1002/prp2.692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023] Open
Abstract
Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient's average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally.
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Affiliation(s)
- Rocío Fernández-Urrusuno
- Clinical Unit Primary Care Pharmacy Sevilla, Aljarafe-Sevilla Norte Primary Health Area, Andalusian Health Service, Seville, Spain
| | | | - Sonia Anaya-Ordóñez
- Service of Pharmacy, Granada Metropolitano Primary Health Care Area, Andalusian Health Service, Granada, Spain
| | | | | | | | - Esther Marco Tejón
- Cuenca Primary Care Management, Hospital Virgen de la Luz, Castilla La Mancha Health Service, Cuenca, Spain
| | | | - Olatz Pérez Rodríguez
- Mallorca Primary Care Management, Islas Baleares Health Service IB-SALUT, Palma de Mallorca, Spain
| | - María García Gil
- Service of Pharmacy, Sagunto Health Care Area, Comunidad Valenciana, Valencia, Spain
| | | | - Genma M Silva Riádigos
- Service of Pharmacy, Ouest Primary Health Care Area, Madrid Health Service, Madrid, Spain
| | | | - Vicente Olmo Quintana
- Service of Pharmacy, Gran Canaria Primary Care Management, Canarian Health Service, Gran Canaria, Spain
| | - M Belén Pina Gadea
- Service of Primary Care Pharmacy, Aragón Health Service, Zaragoza, Spain
| | - Angel García Alvarez
- Tramuntana Primary Care Management, Islas Baleares Health Care Service, Palma de Mallorca, Spain
| | - M Llüisa Sastre Martorell
- Service of Pharmacy, Hospital Universitari Son Espases, Islas Baleares Health Service IB-SALUT, Palma de Mallorca, Spain
| | - Jorge I Jiménez Arce
- Clinical Unit Primary Care Pharmacy Area VII Asturias, Principado de Asturias Health Service, Mieres, Asturias, Spain
| | | | - Joaquín Pérez Martín
- Faculty of Social Sciences, Area of Design, Gaming and Multimedia, European University of Madrid, Madrid, Spain
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14
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Affiliation(s)
- Dominique L Monnet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Stephan Harbarth
- Infection Control Program and Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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