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Durà-Miralles X, Abelenda-Alonso G, Bergas A, Laporte-Amargós J, Sastre-Escolà E, Padullés A, Carratalà J, Gudiol C. An Ocean between the Waves: Trends in Antimicrobial Consumption in Hospitalized Patients with COVID-19. Antibiotics (Basel) 2024; 13:55. [PMID: 38247614 PMCID: PMC10812529 DOI: 10.3390/antibiotics13010055] [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: 12/07/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
We assessed the antibiotic use in SARS-CoV-2-infected patients during four different waves of the COVID-19 pandemic, as well as its trends over the period and associated risk factors. We performed a cross-sectional retrospective analysis nested in a prospectively collected cohort of hospitalized adult patients with COVID-19 at a university hospital in Spain. A total of 2415 patients were included in this study, among whom 1120 corresponded to the first wave. The highest percentage of patients receiving some sort of antibiotic treatment was higher during the first wave (77.6%) than during the others; nevertheless, our calculation of the average DOT (days of antibiotic treatment) per 100 patient days of stay found that the highest antibiotic prescription rate corresponded to the second pandemic wave (61.61 DOT/100 patient days), which was associated with a higher ICU admission rate and a lower SpO2/FiO2 ratio at admission. After the second wave, the prescription rates presented a steady downward trend. With regard to the use of specific antibiotic families, amoxicillin/clavulanate was the most used antibiotic in our cohort (14.20 DOT/100 patient days) due to a high prescription rate during the first wave. According to the "AWaRe" WHO classification, antibiotics corresponding to the "Watch" group were the most prescribed (27.92 DOT/100 patient days). The antibiotic use rate fell progressively, but it remained high during all four waves analyzed. In conclusion, antibiotic use was high throughout all the waves that were analyzed, despite a relatively low incidence of bacterial coinfection and superinfection. Efforts should be made to keep antimicrobial stewardship programs active, especially in complicated epidemiological situations, such as the SARS-CoV-2 pandemic.
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Affiliation(s)
- Xavier Durà-Miralles
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain; (X.D.-M.); (A.B.); (E.S.-E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gabriela Abelenda-Alonso
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain; (X.D.-M.); (A.B.); (E.S.-E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Alba Bergas
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain; (X.D.-M.); (A.B.); (E.S.-E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Júlia Laporte-Amargós
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain; (X.D.-M.); (A.B.); (E.S.-E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Enric Sastre-Escolà
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain; (X.D.-M.); (A.B.); (E.S.-E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Ariadna Padullés
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Department of Pharmacy, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain; (X.D.-M.); (A.B.); (E.S.-E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Facultat de Medicina i Ciències de la Salut, University of Barcelona, Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carlota Gudiol
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain; (X.D.-M.); (A.B.); (E.S.-E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Facultat de Medicina i Ciències de la Salut, University of Barcelona, Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
- Institut Català d’Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain
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Jesmani Y, Bozorgomid A, Shadmani FK, Dehbani A, Sayad B. Demographic and clinical characteristics and outcomes of COVID-19 patients admitted to a university hospital in the west of Iran: a retrospective study in the third wave. VACUNAS 2023; 24:S1576-9887(23)00007-9. [PMID: 36817340 PMCID: PMC9922569 DOI: 10.1016/j.vacun.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Abstract
COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The characteristics of this infectious disease vary from a country to another and from one peak to the next. The aim of the present study was to describe the COVID-19 patients hospitalized in Kermanshah, a city in the west of Iran, in the third peak of the disease and to identify in-hospital mortality determinants in this disease. Methods: In this retrospective study, the clinical and demographic characteristics, laboratory findings, prescribed treatments and outcome of all COVID-19 patients (definitive, suspected, and probable) were collected from the medical records department of Farabi Hospital affiliated with Kermanshah University of Medical Sciences, Kermanshah, Iran from 22 October to 20 November 2020. Results: In total, 665 COVID-19 patients (265 females and 400 males, mean age: 58.7 years) were enrolled, including 479 confirmed, 15 probable, and 30 suspected cases. About 84% of the patients presented with low oxygen saturation levels. The most common comorbidities were hypertension (15%), diabetes (10%), and cardiovascular disease (3%). The median (IQR) length of hospital stay was 6 (Nojomi et al., 2021; Flores-Vega et al., 2022; Fattahi et al., 2021; Cusinato et al., 2022; Avatef Fazeli et al., 2021 (4., 5., 6., 7., 8.)) and 7 (Javadi Mamaghani et al., 2021; Abdolahnejad et al., 2022; Nojomi et al., 2021; Flores-Vega et al., 2022; Fattahi et al., 2021; Cusinato et al., 2022; Avatef Fazeli et al., 2021; Sayad et al., 2021; Hesni et al., 2022; Buttenschøn et al., 2022; Smits et al., 2022; Rosenberger et al., 2021; Shi et al., 2022 (2., 3., 4., 5., 6., 7., 8., 9., 10., 11., 12., 13., 14.)) day in discharged and deceased patients, respectively. Eighty-two out of 655 patients admitted to the hospital and 39of the 60 patients admitted to the ICU died. In total, in-hospital mortality rate was 12.33%. Regarding lab variables, in the adjusted model, no significant difference was observed between discharged and deceased patients.The results of multivariable logistic regression showed that each one-unit increase in oxygen saturation (SPO2) increased the odds of survival by 0.88 times (aOR 0.88, 95% CI 0.78-0.99, p = 0.043). Moreover, each one-day increase in the length of ICU stay reduced the odds of mortality by 0.49 times (aOR 0.82, 95% CI 0.26-0.95, p = 0.035). Conclusion: Hospitalized COVID-19 patients were generally more ill during the third peak so that about 85% of the patients had SPO2 ≤ 93%. The in-hospital mortality rate was also high. Demographic and paraclinical variables (except SPO2 level) were not suitable predictors of mortality.
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Affiliation(s)
- Younes Jesmani
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arezoo Bozorgomid
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Khosravi Shadmani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Dehbani
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Babak Sayad
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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