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Zaha DC, Ilea CDN, Dorobanțu FR, Pantiș C, Pop ON, Dascal DG, Dorobanțu CD, Manole F. The Impact of SARS-CoV-2 Pandemic on Antibiotic Prescriptions and Resistance in a University Hospital from Romania. Antibiotics (Basel) 2024; 13:477. [PMID: 38927144 PMCID: PMC11200525 DOI: 10.3390/antibiotics13060477] [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: 04/30/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
This paper aimed to evaluate the effects of the COVID-19 pandemic on prescription rates and antibiotic resistance in a university hospital. A retrospective study was conducted on the medical records of patients admitted to the Bihor Emergency Clinical County Hospital in Romania in 2019 (pre-pandemic) and 2021 (during the pandemic period). We evaluated the antibiotic consumption index (ACI) and susceptibility rates. The overall percentage of antibiotic prescribing increased in 2021, while the total number of patients decreased. Genito-urinary, digestive, respiratory infections, heart diseases and wounds were the most common conditions for antibiotic prescriptions, but the number of them decreased in 2021. There was a decrease in the proportion of antibiotics from the Watch and Reserve class and an increase in the proportion of antibiotics from the Access class. Antibiotic use has been reduced despite an increase in the number of patients, with a high consumption in the Watch group in the ICU wards. By contrast, surgical wards had the highest rate of antibiotic prescriptions, but a decrease in the number of patients. The patients who were administered antibiotics were hospitalized for diagnoses other than COVID-19. Almost all prescribed antibiotics displayed decreasing sensitivity rates. The number of isolated ESKAPE pathogens, except for Staphylococcus aureus methicillin-resistant strains, were increased. Strategies to control antibiotic prescriptions and the spread of resistant pathogens should be improved.
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Affiliation(s)
- Dana Carmen Zaha
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st University Street, 410087 Oradea, Romania; (D.C.Z.); (D.G.D.)
| | - Codrin Dan Nicolae Ilea
- Bihor Emergency Clinical County Hospital, 410087 Oradea, Romania
- Department of Biostatistics, Faculty of Medicine and Pharmacy, University of Oradea, 1st University Street, 410087 Oradea, Romania
| | - Florica Ramona Dorobanțu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st University Street, 410087 Oradea, Romania;
| | - Carmen Pantiș
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st University Street, 410087 Oradea, Romania; (C.P.); (C.D.D.); (F.M.)
| | - Ovidiu Nicolae Pop
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st University Street, 410087 Oradea, Romania; (C.P.); (C.D.D.); (F.M.)
| | - Dorina Gabriela Dascal
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st University Street, 410087 Oradea, Romania; (D.C.Z.); (D.G.D.)
| | - Cătălin Dorin Dorobanțu
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st University Street, 410087 Oradea, Romania; (C.P.); (C.D.D.); (F.M.)
| | - Felicia Manole
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st University Street, 410087 Oradea, Romania; (C.P.); (C.D.D.); (F.M.)
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Sharma S, Chauhan A, Ranjan A, Mathkor DM, Haque S, Ramniwas S, Tuli HS, Jindal T, Yadav V. Emerging challenges in antimicrobial resistance: implications for pathogenic microorganisms, novel antibiotics, and their impact on sustainability. Front Microbiol 2024; 15:1403168. [PMID: 38741745 PMCID: PMC11089201 DOI: 10.3389/fmicb.2024.1403168] [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] [Received: 03/18/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Overuse of antibiotics is accelerating the antimicrobial resistance among pathogenic microbes which is a growing public health challenge at the global level. Higher resistance causes severe infections, high complications, longer stays at hospitals and even increased mortality rates. Antimicrobial resistance (AMR) has a significant impact on national economies and their health systems, as it affects the productivity of patients or caregivers due to prolonged hospital stays with high economic costs. The main factor of AMR includes improper and excessive use of antimicrobials; lack of access to clean water, sanitation, and hygiene for humans and animals; poor infection prevention and control measures in hospitals; poor access to medicines and vaccines; lack of awareness and knowledge; and irregularities with legislation. AMR represents a global public health problem, for which epidemiological surveillance systems have been established, aiming to promote collaborations directed at the well-being of human and animal health and the balance of the ecosystem. MDR bacteria such as E. coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., Acinetobacter spp., and Klebsiella pneumonia can even cause death. These microorganisms use a variety of antibiotic resistance mechanisms, such as the development of drug-deactivating targets, alterations in antibiotic targets, or a decrease in intracellular antibiotic concentration, to render themselves resistant to numerous antibiotics. In context, the United Nations issued the Sustainable Development Goals (SDGs) in 2015 to serve as a worldwide blueprint for a better, more equal, and more sustainable existence on our planet. The SDGs place antimicrobial resistance (AMR) in the context of global public health and socioeconomic issues; also, the continued growth of AMR may hinder the achievement of numerous SDGs. In this review, we discuss the role of environmental pollution in the rise of AMR, different mechanisms underlying the antibiotic resistance, the threats posed by pathogenic microbes, novel antibiotics, strategies such as One Health to combat AMR, and the impact of resistance on sustainability and sustainable development goals.
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Affiliation(s)
- Shikha Sharma
- Amity Institute of Environmental Sciences, Amity University, Noida, Uttar Pradesh, India
| | - Abhishek Chauhan
- Amity Institute of Environmental Toxicology, Safety and Management, Amity University, Noida, Uttar Pradesh, India
| | - Anuj Ranjan
- Academy of Biology and Biotechnology, Southern Federal University, Rostov-on-Don, Russia
| | - Darin Mansor Mathkor
- Research and Scientific Studies Unit, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Seema Ramniwas
- University Centre for Research & Development, University Institute of Pharmaceutical Sciences, Chandigarh University, Mohali, Punjab, India
| | - Hardeep Singh Tuli
- Department of Bio-Sciences and Technology, Maharishi Markandeshwar Engineering College, Maharishi Markandeshwar (Deemed to Be University), Ambala, India
| | - Tanu Jindal
- Amity Institute of Environmental Toxicology, Safety and Management, Amity University, Noida, Uttar Pradesh, India
| | - Vikas Yadav
- Department of Translational Medicine, Clinical Research Centre, Skåne University Hospital, Lund University, Malmö, Sweden
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Haddad N, Zeenny RM, El Halabi C, Abdallah T, El Helou R, Zahreddine NK, Kanj SS, Rizk NA. The experience of an antimicrobial stewardship program and antibiotic consumption and resistance trends during the COVID-19 pandemic at a tertiary care center in Beirut. J Infect Public Health 2024; 17:254-262. [PMID: 38128409 DOI: 10.1016/j.jiph.2023.12.007] [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: 09/14/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Antimicrobial Resistance, a global concern, worsened with the COVID-19 pandemic that caused a surge of critically ill patients, increased antimicrobial consumption, and the spread of infections with multidrug-resistant organisms (MDROs). Antimicrobial Stewardship Programs (ASP) aim to optimize antimicrobial utilization to fight resistance. We aim to describe the ASP experience and to study antimicrobial consumption and MDRO rates among COVID-19 patients at a tertiary care center in Beirut. METHODS We compiled the ASP interventions, defined as ASP team recommendations, from January 2019 until December 2021. Data on antimicrobial consumption, expressed as a defined daily dose (DDD) per 100 patient days, was collected per quarter for all antimicrobials and restricted antimicrobials per ASP guidance. Our primary objective was to report on the ASP experience, and the secondary objective was to reflect on the rates of MDROs among hospitalized COVID-19 patients with respiratory or bloodstream bacterial co-infections between March 2020 and September 2021. RESULTS 9922 ASP interventions were documented during this study period, with a noticeable correlation between COVID-19 surges in Lebanon and the number of ASP interventions. Acceptance rates for these recommendations improved over time, with a noticeable decrease in the proportion of interventions related to de-escalation and discontinuation of broad-spectrum antimicrobials. We noted an increase in all antimicrobial consumption after the onset of the pandemic, peaking in Q4 2020 (142.8 DDD of anti-infectives/100 patient days) and Q1 2021 (79.1 DDD of restricted anti-infectives/100 patient days). As expected, MDROs, particularly ESKAPE organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Carbapenem-resistant Enterobacteriaceae) accounted for 24% of isolates obtained from this cohort. CONCLUSION This study highlights the experience of the ASP as we adapted to the COVID-19 pandemic. The ASP team maintained its operations and continued to monitor antibiotic consumption and provide recommendations to limit antibiotic misuse in an effort to mitigate the impact of the pandemic on antimicrobial resistance.
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Affiliation(s)
- Nisrine Haddad
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rony M Zeenny
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Celia El Halabi
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamara Abdallah
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Remie El Helou
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Kara Zahreddine
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Nesrine A Rizk
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
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Krockow EM, Cheng KO, Maltby J, McElroy E. Existing terminology related to antimicrobial resistance fails to evoke risk perceptions and be remembered. COMMUNICATIONS MEDICINE 2023; 3:149. [PMID: 37880476 PMCID: PMC10600229 DOI: 10.1038/s43856-023-00379-6] [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: 10/11/2022] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global healthcare threat promoted by all use of antibiotics. Hence, reducing overuse of antibiotics is essential. The necessary behaviour change relies on effective public health communication, but previous information campaigns-while showing some successes-have fallen short in generating a lasting increase of public awareness. A potential reason for this is AMR-related terminology, which has been criticised as inconsistent, abstract and difficult to pronounce. We report the first empirical test of word memorability and risk association for the most frequent AMR-related health terms. METHODS Across two surveys sampling 237 US and 924 UK participants, we test people's memory for and the risk they associate with six AMR-related terms and thirty-four additional health risk terms (e.g., cancer). Participants also rate the terms on different linguistic dimensions including concreteness, familiarity, processing fluency and pronounceability. RESULTS Our findings suggest that existing AMR-related health terms-particularly "AMR" and "Antimicrobial resistance"-are unsuitable for public health communication, because they score consistently low on both memorability and risk association. Out of the AMR terms, "Antibiotic resistance" and-to a lesser extent-"Drug-resistant infections" perform best. Regression analyses suggest that linguistic attributes (e.g., familiarity, processing fluency, pronounceability) are predictors of the terms' risk association. CONCLUSIONS Our findings highlight an urgent need to rename AMR with a memorable term that effectively signals the existential threat of AMR and thereby motivates a change in antibiotic use. The success of the revised term is likely to depend, at least partially, on its linguistic attributes.
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Affiliation(s)
- Eva M Krockow
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK.
| | - Kate O Cheng
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - John Maltby
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - Eoin McElroy
- School of Psychology, Ulster University, Coleraine, UK
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5
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Hosseini M, Ahmed Hamad M, Mohseni G, Salamy S, Dehghan Tarzjani S, Taati Moghadam M. Prediction of tsunami of resistance to some antibiotics is not far-fetched which used during COVID-19 pandemic. J Clin Lab Anal 2023; 37:e24959. [PMID: 37650531 PMCID: PMC10561589 DOI: 10.1002/jcla.24959] [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: 01/17/2023] [Revised: 07/19/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023] Open
Abstract
One of the most tragic events in recent history was the COVID-19 outbreak, which has caused thousands of deaths. A variety of drugs were prescribed to improve the condition of patients, including antiparasitic, antiviral, antibiotics, and anti-inflammatory medicines. It must be understood, however, that COVID-19 is like a tip of an iceberg on the ocean, and the consequences of overuse of antibiotics are like the body of a mountain under water whose greatness has not yet been determined for humanity, and additional study is needed to understand them. History of the war between microbes and antimicrobial agents has shown that microbes are intelligent organisms that win over antimicrobial agents over time through many acquired or inherent mechanisms. The key terms containing "COVID-19," "Severe acute respiratory syndrome coronavirus-2," "SARS-CoV2," "Antibiotic Resistance," "Coronavirus," "Pandemic," "Antibiotics," and "Antimicrobial Resistance" were used for searching in PubMed, Scopus, and Google Scholar databases. The COVID-19 pandemic has resulted in an increased prescription of antibiotics. Infections caused by secondary or co-bacterial infections or beneficial bacteria in the body can be increased as a result of this amount of antibiotic prescription and exposure to antibiotics. Antibiotic resistance will likely pose a major problem in the future, especially for last resort antibiotics. In order to address the antibiotic resistance crisis, it is imperative that researchers, farmers, veterinarians, physicians, public and policymakers, pharmacists, other health and environmental professionals, and others collaborate during and beyond this pandemic.
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Affiliation(s)
- Mandana Hosseini
- Department of Microbiology, Tehran North Branch, Islamic Azad University, Tehran, Iran
| | - Mohammed Ahmed Hamad
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Golazin Mohseni
- Department of Microbiology, Tonekabon Branch, Azad University, Tonekabon, Iran
| | - Shakiba Salamy
- Department of Microbiology, Faculty of Pharmacy, Islamic Azad University, Tehran, Iran
| | - Shabnam Dehghan Tarzjani
- Department of Cellular and Molecular Biology, Tehran Center Branch, Islamic Azad University, Tehran, Iran
| | - Majid Taati Moghadam
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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6
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Patel TS, McGovern OL, Mahon G, Osuka H, Boszczowski I, Munita JM, Garzon MI, Salomao MC, Marssola G, Tavares BM, Francisco DB, Gurgel APA, Arantes T, Bori A, Nogueira C, Peters A, Spencer M, Orellana C, Barbe M, Lopez C, Stender S, Lessa FC. Trends in Inpatient Antibiotic Use Among Adults Hospitalized During the Coronavirus Disease 2019 Pandemic in Argentina, Brazil, and Chile, 2018-2021. Clin Infect Dis 2023; 77:S4-S11. [PMID: 37406043 DOI: 10.1093/cid/ciad261] [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: 02/01/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND High rates of antibiotic use (AU) among inpatients with coronavirus disease 2019 (COVID-19) despite low rates of bacterial coinfection and secondary infection have been reported. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in South America. METHODS We conducted an ecologic evaluation of AU in inpatient adult acute care wards in 2 HCFs each in Argentina, Brazil, and Chile. The AU rates for intravenous antibiotics were calculated as the defined daily dose per 1000 patient-days, using pharmacy dispensing records and hospitalization data from March 2018-February 2020 (prepandemic) and March 2020-February 2021 (pandemic). Differences in median AU were compared between the prepandemic and pandemic periods, using the Wilcoxon rank sum test to determine significance. Interrupted time series analysis was used to analyze changes in AU during the COVID-19 pandemic. RESULTS Compared with the prepandemic period, the median difference in AU rates for all antibiotics combined increased in 4 of 6 HCFs (percentage change, 6.7%-35.1%; P < .05). In the interrupted time series models, 5 of 6 HCFs had significant increases in use of all antibiotics combined immediately at the onset of the pandemic (immediate effect estimate range, 15.4-268), but only 1 of these 5 HCFs experienced a sustained increase over time (change in slope, +8.13; P < .01). The effect of the pandemic onset varied by antibiotic group and HCF. CONCLUSIONS Substantial increases in AU were observed at the beginning of the COVID-19 pandemic, suggesting the need to maintain or strengthen antibiotic stewardship activities as part of pandemic or emergency HCF responses.
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Affiliation(s)
- Twisha S Patel
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chenega Enterprise Systems and Solutions Chesapeake, Virginia, USA
| | - Olivia L McGovern
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Garrett Mahon
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CACI International, Reston, Virginia, USA
| | - Hanako Osuka
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chenega Enterprise Systems and Solutions Chesapeake, Virginia, USA
| | - Icaro Boszczowski
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Jose M Munita
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Maria Isabel Garzon
- Servicio de Infectología, Hospital Privado de Córdoba, Cordoba, Argentina
- Hospital Español, Córdoba, Argentina
| | - Matias C Salomao
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | | | - Bruno M Tavares
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Tiago Arantes
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | - Andrea Bori
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | | | - Anne Peters
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Maria Spencer
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Cristian Orellana
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Mario Barbe
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | | | - Fernanda C Lessa
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kamere N, Rutter V, Munkombwe D, Aywak DA, Muro EP, Kaminyoghe F, Rajab K, Lawal MO, Muriithi N, Kusu N, Karimu O, Barlatt SHA, Nambatya W, Ashiru-Oredope D. Supply-chain factors and antimicrobial stewardship. Bull World Health Organ 2023; 101:403-411. [PMID: 37265674 PMCID: PMC10225941 DOI: 10.2471/blt.22.288650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 06/03/2023] Open
Abstract
Efficient and secure supply chains are vital for effective health services worldwide. In low- and middle-income countries, the accessibility, affordability and availability of essential medicines, including antimicrobials, remain challenging. Ineffective supply chains often cause antimicrobial shortages, leading to inappropriate use of alternative agents and increasing the risk of antimicrobial resistance. Shortages, coupled with insecure supply chains, also encourage the infiltration of substandard and falsified medicines, leading to suboptimal treatment and further promoting antimicrobial resistance. Addressing antimicrobial supply-chain issues should be considered a key component of antimicrobial stewardship programmes. We have explored the link between medicine supply chains and antimicrobial use in seven focus countries: Kenya, Malawi, Nigeria, Sierra Leone, Uganda, United Republic of Tanzania and Zambia. We explored country medicine supply-system structures, national medicine supply-chain policy documents and global study reports. Our aim was to develop evidence-based strategies to enhance the effectiveness and efficiency of the medicine supply chains in supporting antimicrobial stewardship efforts. Better management of medical supply chains involves rational selection, quantification, forecasting, procurement, storage, distribution, use and stock management of antimicrobials. Important supply-chain considerations include pooled procurement networks to ensure consistent pricing of quality-assured antimicrobials, and improved resource utilization and information exchange among relevant stakeholders. We propose adaptable recommendations for integrating medicine supply chains as an essential part of antimicrobial stewardship programmes, with a call for action at the local, regional and national levels in low- and middle-income countries.
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Affiliation(s)
- Nduta Kamere
- Commonwealth Pharmacists Association, London, England
| | | | | | | | - Eva Prosper Muro
- Kilimanjaro Christian Medical University College, Kilimanjaro, United Republic of Tanzania
| | | | - Kalidi Rajab
- Makerere University Pharmacy Department, Kampala, Uganda
| | | | | | - Ndinda Kusu
- Medicines, Technologies, and Pharmaceutical Services Program, Management Sciences for Health, Nairobi, Kenya
| | - Oluwatoyin Karimu
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
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8
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Elshenawy RA, Umaru N, Alharbi AB, Aslanpour Z. Antimicrobial stewardship implementation before and during the COVID-19 pandemic in the acute care settings: a systematic review. BMC Public Health 2023; 23:309. [PMID: 36765323 PMCID: PMC9918338 DOI: 10.1186/s12889-023-15072-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Antibiotics are widely administered for various indications, leading to increased antimicrobial resistance (AMR) in acute care hospitals. Since the onset of the COVID-19 pandemic, Antimicrobial Stewardship (AMS) effective strategies should be used to maintain the rational use of antibiotics and decrease the threat of Antimicrobial Resistance (AMR). AIM This systematic literature review aims to investigate the AMS intervention Before-the-pandemic (BP) and During-the-pandemic (DP) from the literature. DESIGN AND SETTING Systematic literature review of primary studies on AMS implementation in acute care settings. METHODS Relevant studies published between 2000 and March 2021 were obtained from Medline (via PubMed), OVID, CINAHL, International Pharmaceutical Abstracts, Psych Info, Scopus, Web of Science, Cochrane Library, OpenGrey, and Google Scholar, using a comprehensive list of search terms. Public Health England (PHE) toolkit was agreed upon as a gold standard for the AMS implementation. RESULTS There were 8763 articles retrieved from the databases. Out of these, 13 full-text articles met the inclusion criteria for the review. The AMS implementation was identified in the included studies into AMS strategies (Core strategies & Supplemental strategies), and AMS measures BP and DP. CONCLUSION This Systematic literature review summarises AMS implementation strategies and measures all over the previous 20 years of research. There are many lessons learnt from COVID-19 pandemic. The proper selection of the AMS implementation strategies and measures appeared to be effective in maintaining the appropriate use of antibiotics and decreasing the AMR threat, especially during the COVID-19 pandemic. Further studies are required to provide empirical data to evaluate the AMS implementation and identify which of these strategies and measures were effective BP and DP. In order to be prepared for any emergency/crisis or future pandemics.
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Affiliation(s)
- Rasha Abdelsalam Elshenawy
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire School of Life and Medical Sciences, Hatfield, AL10 9AB, UK.
| | - Nkiruka Umaru
- grid.5846.f0000 0001 2161 9644Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire School of Life and Medical Sciences, Hatfield, AL10 9AB UK
| | - Amal Bandar Alharbi
- grid.5846.f0000 0001 2161 9644Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire School of Life and Medical Sciences, Hatfield, AL10 9AB UK
| | - Zoe Aslanpour
- grid.5846.f0000 0001 2161 9644Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire School of Life and Medical Sciences, Hatfield, AL10 9AB UK
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9
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Increasing Consumption of Antibiotics during the COVID-19 Pandemic: Implications for Patient Health and Emerging Anti-Microbial Resistance. Antibiotics (Basel) 2022; 12:antibiotics12010045. [PMID: 36671246 PMCID: PMC9855050 DOI: 10.3390/antibiotics12010045] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022] Open
Abstract
The emergence of COVID-19 infection led to the indiscriminate use of antimicrobials without knowing their efficacy in treating the disease. The gratuitous use of antibiotics for COVID-19 treatment raises concerns about the emergence of antimicrobial resistance (AMR). In this systematic review, we performed a thorough systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of scientific databases (Scopus, Web of Science, and PubMed) to identify studies where antibiotics were prescribed to treat COVID-19 (December 2019 to December 2021). Of 970 identified studies, 130 were included in our analyses. Almost 78% of COVID-19 patients have been prescribed an antibiotic. Cephalosporins were the most prescribed (30.1% of patients) antibiotics, followed by azithromycin (26% of patients). Antibiotics were prescribed for COVID-19 patients regardless of reported severity; the overall rate of antibiotic use was similar when comparing patients with a severe or critical illness (77.4%) and patients with mild or moderate illness (76.8%). Secondary infections were mentioned in only 11 studies. We conclude that concerns related to COVID-19 and the lack of treatment strategy led to the overuse of antibiotics without proper clinical rationale. Based on our findings, we propose that antimicrobial stewardship should be retained as a priority while treating viral pandemics.
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10
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Walflor HSM, Lucena ARC, Tuon FF, Medeiros LCS, Faoro H. Resensitization of Fosfomycin-Resistant Escherichia coli Using the CRISPR System. Int J Mol Sci 2022; 23:9175. [PMID: 36012441 PMCID: PMC9409345 DOI: 10.3390/ijms23169175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial resistance is a public health burden with worldwide impacts and was recently identified as one of the major causes of death in 2019. Fosfomycin is an antibiotic commonly used to treat urinary tract infections, and resistance to it in Enterobacteriaceae is mainly due to the metalloenzyme FosA3 encoded by the fosA3 gene. In this work, we adapted a CRISPR-Cas9 system named pRE-FOSA3 to restore the sensitivity of a fosA3+ Escherichia coli strain. The fosA3+ E. coli strain was generated by transforming synthetic fosA3 into a nonpathogenic E. coli TOP10. To mediate the fosA3 disruption, two guide RNAs (gRNAs) were selected that used conserved regions within the fosA3 sequence of more than 700 fosA3+ E. coli isolates, and the resensitization plasmid pRE-FOSA3 was assembled by cloning the gRNA into pCas9. gRNA_195 exhibited 100% efficiency in resensitizing the bacteria to fosfomycin. Additionally, the edited strain lost the ampicillin resistance encoded in the same plasmid containing the synthetic fosA3 gene, despite not being the CRISPR-Cas9 target, indicating plasmid clearance. The in vitro analysis presented here points to a path that can be explored to assist the development of effective alternative methods of treatment against fosA3+ bacteria.
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Affiliation(s)
- Haniel Siqueira Mortagua Walflor
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Fiocruz, Curitiba 81350-010, PR, Brazil
- Laboratory of Cell Biology, Carlos Chagas Institute, Fiocruz, Curitiba 81350-010, PR, Brazil
| | - Aline Rodrigues Castro Lucena
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Fiocruz, Curitiba 81350-010, PR, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba 80215-901, PR, Brazil
| | | | - Helisson Faoro
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Fiocruz, Curitiba 81350-010, PR, Brazil
- Graduate Program on Bioinformatics, Federal University of Paraná, Curitiba 81520-260, PR, Brazil
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11
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Carbapenem use correlates with percentage of patients with COVID-19 in intensive care units. Infection 2022; 51:331-336. [PMID: 35716341 PMCID: PMC9206090 DOI: 10.1007/s15010-022-01867-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The first wave of COVID-19 pandemic may have significantly impacted antimicrobial consumption in hospitals. The objective of this study was to assess the evolution of carbapenem consumption and describe the implemented measures during the first year of the COVID-19 pandemic. METHODS We calculated carbapenem consumption for all the hospital and for intensive care units (ICU) for three periods: baseline (before COVID-19 cases, January 2019-February 2020), and the period of COVID-19 cases as a pre-intervention (March-August 2020) and a post-intervention phase (September 2020-December 2021). RESULTS During the study period, the percentage of admitted COVID-19 patients increased in the months of April-August of 2020 (pre-intervention period) from 5 to 26% of total admitted patients. The consumption of carbapenems (DDD/1000 patient days) increased from a mean of 67.1 at baseline to 142.9 pre-intervention. In ICUS, there was an increase in the mean from 125.7 to 240.8 DDD/1000 patient days. After interventions, the DDD/1000 patient days decreased by 49.5% overall the hospital and by 36% in ICUs. For the post-intervention period, there was a correlation between COVID-19 cases and carbapenem usage in the ICU but not the overall hospital. CONCLUSION An increase in the antimicrobial consumption during the first wave of COVID-19 pandemic was noticed, especially in the ICU. Antimicrobial stewardship programs are essential to reduce consumption rate.
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Antibiotic Stewardship in Disaster Situations: Lessons Learned in Lebanon. Antibiotics (Basel) 2022; 11:antibiotics11050560. [PMID: 35625204 PMCID: PMC9137475 DOI: 10.3390/antibiotics11050560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 01/27/2023] Open
Abstract
A post-prescription review and feedback program was implemented as an antimicrobial stewardship intervention in Lebanon as the country grappled with complete economic collapse, the COVID-19 pandemic, and a large blast in Beirut. We describe the implications of antimicrobial use in disaster preparedness and crisis situations, the sequelae related to increasing antimicrobial resistance, and our lessons learned in Lebanon. We explore opportunities and potential solutions for future disaster preparedness.
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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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14
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Borek AJ, Maitland K, McLeod M, Campbell A, Hayhoe B, Butler CC, Morrell L, Roope LSJ, Holmes A, Walker AS, Tonkin-Crine S. Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England. Antibiotics (Basel) 2021; 10:antibiotics10121531. [PMID: 34943743 PMCID: PMC8698307 DOI: 10.3390/antibiotics10121531] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 01/21/2023] Open
Abstract
The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived the pandemic as having had less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations) in addition to changing patient presentations and GP workloads as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. The pandemic disrupted, and required adaptations in, the usual ways of working and AMS. It is now important to identify opportunities, e.g., for re-organising ways of managing infections and AMS in the future.
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Affiliation(s)
- Aleksandra J. Borek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (K.M.); (C.C.B.); (S.T.-C.)
- Correspondence:
| | - Katherine Maitland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (K.M.); (C.C.B.); (S.T.-C.)
| | - Monsey McLeod
- National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK; (M.M.); (A.C.); (A.H.)
- Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London W6 8RF, UK
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London W6 8RF, UK
| | - Anne Campbell
- National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK; (M.M.); (A.C.); (A.H.)
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK;
- NIHR Applied Research Collaboration Northwest London, London W6 8RP, UK
| | - Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (K.M.); (C.C.B.); (S.T.-C.)
| | - Liz Morrell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (L.M.); (L.S.J.R.)
| | - Laurence S. J. Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (L.M.); (L.S.J.R.)
- NIHR Oxford Biomedical Research Centre, Oxford OX3 9DU, UK;
| | - Alison Holmes
- National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK; (M.M.); (A.C.); (A.H.)
| | - Ann Sarah Walker
- NIHR Oxford Biomedical Research Centre, Oxford OX3 9DU, UK;
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (K.M.); (C.C.B.); (S.T.-C.)
- NIHR Oxford Biomedical Research Centre, Oxford OX3 9DU, UK;
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Vélez-Páez JL, Tercero-Martínez W, Jiménez-Alulima G, Navarrete-Domínguez J, Cornejo-Loor L, Castro-Bustamante C, Cabanillas-Lazo M, Barboza JJ, Rodriguez-Morales AJ. Neutrophil-to-lymphocyte ratio and mean platelet volume in the diagnosis of bacterial infections in COVID-19 patients. A preliminary analysis from Ecuador. LE INFEZIONI IN MEDICINA 2021; 29:530-537. [PMID: 35146361 PMCID: PMC8805481 DOI: 10.53854/liim-2904-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Hospitalized COVID-19 patients are at risk of hospital infection. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-C-reactive protein ratio (LCR) and mean platelet volume (MPV) are established inflammation markers reflecting the systemic inflammatory response. The objective of this study was to evaluate the clinical characteristics of patients with COVID-19 and bacterial co-infections, as well as the correlation with NLR and MPV. METHODS We assessed the role of the NLR and MPV in diagnosing bacterial infections in COVID-19 patients. The Wilcoxon test was used to compare the mean NLR and MPV between the diagnostic evaluation moments, while the Mann-Whitney test was used to compare NLR and MPV by sex and age. RESULTS The NLR was compared three days before the culture and the day of taking the culture, observing significant differences (p=0.020). MPV three days before the culture and the day of the culture were compared, also observing significant differences (p=0.031). NLR and MPV were compared at the different evaluation times according to sex and age group, observing for the age group significant differences for the NLR three days before the culture (p=0.004). CONCLUSION In our study, there were significant differences in NLR and MPV between the three days before culture and the day of culture. It is advisable to continue to enrol more patients in the study so that in the future, we can add results on the diagnostic accuracy of the NLR and MPV in the timely diagnosis of bacterial infection in patients with COVID-19.
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Affiliation(s)
- Jorge Luis Vélez-Páez
- Unidad de Cuidados Intensivos, Centro de Investigación Clínica, Hospital Pablo Arturo Suárez, Quito, Ecuador
- Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | - Wendy Tercero-Martínez
- Unidad de Cuidados Intensivos, Centro de Investigación Clínica, Hospital Pablo Arturo Suárez, Quito, Ecuador
| | - Glenda Jiménez-Alulima
- Unidad de Cuidados Intensivos, Centro de Investigación Clínica, Hospital Pablo Arturo Suárez, Quito, Ecuador
| | - Johanna Navarrete-Domínguez
- Unidad de Cuidados Intensivos, Centro de Investigación Clínica, Hospital Pablo Arturo Suárez, Quito, Ecuador
| | - Luis Cornejo-Loor
- Unidad de Cuidados Intensivos, Centro de Investigación Clínica, Hospital Pablo Arturo Suárez, Quito, Ecuador
| | - Christian Castro-Bustamante
- Unidad de Cuidados Intensivos, Centro de Investigación Clínica, Hospital Pablo Arturo Suárez, Quito, Ecuador
| | - Miguel Cabanillas-Lazo
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Tau-Relaped Group, Trujillo, Peru
| | - Joshuan J. Barboza
- Escuela de Medicina, Universidad Señor de Sipán, Chiclayo, Peru
- Tau-Relaped Group, Trujillo, Peru
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de Las Americas, Pereira, Risaralda, Colombia
- Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- School of Medicine, Universidad Privada Franz Tamayo, Cochabamba, Bolivia
- Faculty of Health Sciences, Universidad Cientifica del Sur, Lima, Peru
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16
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Llor C, Ouchi D, Giner-Soriano M, García-Sangenís A, Bjerrum L, Morros R. Correlation between Previous Antibiotic Exposure and COVID-19 Severity. A Population-Based Cohort Study. Antibiotics (Basel) 2021; 10:antibiotics10111364. [PMID: 34827302 PMCID: PMC8615228 DOI: 10.3390/antibiotics10111364] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/25/2021] [Accepted: 11/05/2021] [Indexed: 12/23/2022] Open
Abstract
We examined the correlation between previous antibiotic exposure and COVID-19 severity using a population-based observational matched cohort study with patient level data obtained for more than 5.8 million people registered in SIDIAP in Catalonia, Spain. We included all patients newly diagnosed with COVID-19 from March to June 2020 and identified all their antibiotic prescriptions in the previous two years. We used a composite severity endpoint, including pneumonia, hospital admission and death due to COVID-19. We examined the influence of high antibiotic exposure (>4 regimens), exposure to highest priority critically important antimicrobials (HPCIA) and recent exposure. Potential confounders were adjusted by logistic regression. A total of 280,679 patients were diagnosed with COVID-19, 146,656 of whom were exposed to at least one antibiotic course (52.3%) during the preceding two years. A total of 25,222 presented severe COVID-19 infection (9%), and the risk of severity was highest among those exposed to antibiotics (OR 1.12; 95% CI: 1.04–1.21). Among all individuals exposed to antibiotics, high, recent and exposure to HPCIAs were correlated with increased COVID severity (OR 1.19; 95% CI: 1.14–1.26; 1.41; 95% CI: 1.36–1.46; and 1.35; 95% CI: 1.30–1.40, respectively). Our findings confirm a significant correlation between previous antibiotic exposure and increased severity of COVID-19 disease.
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Affiliation(s)
- Carl Llor
- Fundació Institut Universitari per la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (D.O.); (M.G.-S.); (A.G.-S.); (R.M.)
- Department of Public Health, General Practice, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence:
| | - Dan Ouchi
- Fundació Institut Universitari per la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (D.O.); (M.G.-S.); (A.G.-S.); (R.M.)
- Universitat Autònoma de Barcelona, Bellaterra, 08193 Cerdanyola del Vallès, Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (D.O.); (M.G.-S.); (A.G.-S.); (R.M.)
- Universitat Autònoma de Barcelona, Bellaterra, 08193 Cerdanyola del Vallès, Spain
| | - Ana García-Sangenís
- Fundació Institut Universitari per la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (D.O.); (M.G.-S.); (A.G.-S.); (R.M.)
| | - Lars Bjerrum
- Section and Research Unit of General Practice, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
| | - Rosa Morros
- Fundació Institut Universitari per la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (D.O.); (M.G.-S.); (A.G.-S.); (R.M.)
- Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, 08193 Cerdanyola del Vallès, Spain
- Plataforma SCReN, IICEC IDIAP Jordi Gol, 08007 Barcelona, Spain
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17
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Rizk NA, Moghnieh R, Haddad N, Rebeiz MC, Zeenny RM, Hindy JR, Orlando G, Kanj SS. Challenges to Antimicrobial Stewardship in the Countries of the Arab League: Concerns of Worsening Resistance during the COVID-19 Pandemic and Proposed Solutions. Antibiotics (Basel) 2021; 10:antibiotics10111320. [PMID: 34827257 PMCID: PMC8614706 DOI: 10.3390/antibiotics10111320] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/15/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic is expected to worsen the global problem of antimicrobial resistance (AMR). There is a heightened interest in understanding this effect and to develop antimicrobial stewardship (AMS) interventions accordingly to curb this threat. Our paper aims to evaluate the potential magnitude of COVID-19 on AMR and AMS with a focus on the countries of the Arab league, given the social, political, and economic environments. We also evaluate obstacles in applying the rational use of antibiotics, monitoring resistance trends in the midst of the pandemic, and evaluating the impact of the economic crisis in some countries. We aim to raise awareness about the potential effects of antibiotic overuse during the pandemic and to propose practical approaches to tackle this issue.
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Affiliation(s)
- Nesrine A. Rizk
- Division of Infectious Diseases, Internal Medicine Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Rima Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut P.O. Box 11-6301, Lebanon;
| | - Nisrine Haddad
- Pharmacy Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.H.); (R.M.Z.)
| | - Marie-Claire Rebeiz
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Rony M. Zeenny
- Pharmacy Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.H.); (R.M.Z.)
| | - Joya-Rita Hindy
- Division of Infectious Diseases, Internal Medicine Department, Mayo Clinic, Rochester, MN 55902, USA;
| | - Gabriella Orlando
- Infectious Disease Clinic, Policlinico University Hospital, 41122 Modena, Italy;
| | - Souha S. Kanj
- Division of Infectious Diseases, Internal Medicine Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
- Correspondence:
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The Pandemic beyond the Pandemic: A Scoping Review on the Social Relationships between COVID-19 and Antimicrobial Resistance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168766. [PMID: 34444511 PMCID: PMC8391257 DOI: 10.3390/ijerph18168766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/23/2022]
Abstract
The social sciences are essential to include in the fight against both public health challenges of antimicrobial resistance (AMR) and COVID-19. In this scoping review, we document what social science knowledge has been published about the social relationship between COVID-19 and AMR and which social science interventions are suggested to address this social relationship. We analysed 23 peer-reviewed articles published between 2019 and 2021. Results emphasize that changes in antibiotic prescription behaviour, misinformation, over-burdened health systems, financial hardship, environmental impact and gaps in governance might increase the improper access and use of antibiotics during the COVID-19 pandemic, increasing AMR. The identified social sciences transformation strategies include social engagement and sensitisation, misinformation control, health systems strengthening, improved infection prevention and control measures, environmental protection, and better antimicrobial stewardship and infectious diseases governance. The review emphasizes the importance of interdisciplinary research in addressing both AMR and COVID-19.
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19
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Grau S, Hernández S, Echeverría-Esnal D, Almendral A, Ferrer R, Limón E, Horcajada JP. Antimicrobial Consumption among 66 Acute Care Hospitals in Catalonia: Impact of the COVID-19 Pandemic. Antibiotics (Basel) 2021; 10:943. [PMID: 34438993 PMCID: PMC8388964 DOI: 10.3390/antibiotics10080943] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Antimicrobials have been widely used during the COVID-19 pandemic. This study aimed to analyze the impact of the COVID-19 pandemic on the antimicrobial consumption of 66 hospitals in Catalonia. METHODS Adult antibacterial and antimycotic consumption was calculated as defined daily doses (DDD)/100 bed-days and DDD/100 discharges. Firstly, overall and ICU consumption in 2019 and 2020 were compared. Secondly, observed ICU 2020 consumptions were compared with non-COVID-19 2020 estimated consumptions (based on the trend from 2008-2019). RESULTS Overall, antibacterial consumption increased by 2.31% and 4.15% DDD/100 bed-days and DDD/100 discharges, respectively. Azithromycin (105.4% and 109.08% DDD/100 bed-days and DDD/100 discharges, respectively) and ceftriaxone (25.72% and 27.97% DDD/100 bed-days and DDD/100 discharges, respectively) mainly accounted for this finding. Likewise, antifungal consumption increased by 10.25% DDD/100 bed-days and 12.22% DDD/100 discharges, mainly due to echinocandins or amphotericin B. ICU antibacterial and antimycotic consumption decreased by 1.28% and 4.35% DDD/100 bed-days, respectively. On the contrary, antibacterial and antifungal use, expressed in DDD/100 discharges, increased by 23.42% and 19.58%. Azithromycin (275.09%), ceftriaxone (55.11%), cefepime (106.35%), vancomycin (29.81%), linezolid (31.28%), amphotericin B (87.98%), and voriconazole (96.17%) use changed the most. Observed consumption of amphotericin B, azithromycin, caspofungin, ceftriaxone, vancomycin, and voriconazole were higher than estimated values. CONCLUSIONS The consumption indicators for most antimicrobials deviated from the expected trend pattern. A worrisome increase in antibacterial and antifungal consumption was observed in ICUs in Catalonia.
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Affiliation(s)
- Santiago Grau
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25–29, 08003 Barcelona, Spain;
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
- Department of Pharmacology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Sergi Hernández
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08907 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Daniel Echeverría-Esnal
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25–29, 08003 Barcelona, Spain;
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
| | - Alexander Almendral
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08907 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Ricard Ferrer
- Department of Intensive Care Medicine, Hospital Universitario Vall D’Hebron, Passeig de la Vall D’Hebron 119, 08035 Barcelona, Spain;
| | - Enric Limón
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08907 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Juan Pablo Horcajada
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
- Infectious Diseases Department, Hospital del Mar, Passeig Maritim 25–29, 08003 Barcelona, Spain
- Department of Medicine, CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain
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20
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Rose AN, Baggs J, Wolford H, Neuhauser MM, Srinivasan A, Gundlapalli AV, Reddy S, Kompaniyets L, Pennington AF, Grigg C, Kabbani S. Trends in Antibiotic Use in United States Hospitals During the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2021; 8:ofab236. [PMID: 34226869 PMCID: PMC8244661 DOI: 10.1093/ofid/ofab236] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
We described antibiotic use among inpatients with coronavirus disease 2019 (COVID-19). Most
COVID-19 inpatients received antibiotic therapy. We also described hospital-wide antibiotic use
during 2020 compared with 2019, stratified by hospital COVID-19 burden. Although total
antibiotic use decreased between years, certain antibiotic use increased with higher COVID-19
burden.
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Affiliation(s)
- Ashley N Rose
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Baggs
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hannah Wolford
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melinda M Neuhauser
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Arjun Srinivasan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adi V Gundlapalli
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sujan Reddy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lyudmyla Kompaniyets
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Audrey F Pennington
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheri Grigg
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Kabbani
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Wind LL, Briganti JS, Brown AM, Neher TP, Davis MF, Durso LM, Spicer T, Lansing S. Finding What Is Inaccessible: Antimicrobial Resistance Language Use among the One Health Domains. Antibiotics (Basel) 2021; 10:385. [PMID: 33916878 PMCID: PMC8065768 DOI: 10.3390/antibiotics10040385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
The success of a One Health approach to combating antimicrobial resistance (AMR) requires effective data sharing across the three One Health domains (human, animal, and environment). To investigate if there are differences in language use across the One Health domains, we examined the peer-reviewed literature using a combination of text data mining and natural language processing techniques on 20,000 open-access articles related to AMR and One Health. Evaluating AMR key term frequency from the European PubMed Collection published between 1990 and 2019 showed distinct AMR language usage within each domain and incongruent language usage across domains, with significant differences in key term usage frequencies when articles were grouped by the One Health sub-specialties (2-way ANOVA; p < 0.001). Over the 29-year period, "antibiotic resistance" and "AR" were used 18 times more than "antimicrobial resistance" and "AMR". The discord of language use across One Health potentially weakens the effectiveness of interdisciplinary research by creating accessibility issues for researchers using search engines. This research was the first to quantify this disparate language use within One Health, which inhibits collaboration and crosstalk between domains. We suggest the following for authors publishing AMR-related research within the One Health context: (1) increase title/abstract searchability by including both antimicrobial and antibiotic resistance related search terms; (2) include "One Health" in the title/abstract; and (3) prioritize open-access publication.
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Affiliation(s)
- Lauren L. Wind
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, VA 24060, USA
| | - Jonathan S. Briganti
- University Libraries, Virginia Tech, Blacksburg, VA 24060, USA; (J.S.B.); (A.M.B.); (T.S.)
| | - Anne M. Brown
- University Libraries, Virginia Tech, Blacksburg, VA 24060, USA; (J.S.B.); (A.M.B.); (T.S.)
| | - Timothy P. Neher
- Department of Agricultural and Biosystems Engineering, Iowa State University, Ames, IA 50011, USA;
| | - Meghan F. Davis
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | | | - Tanner Spicer
- University Libraries, Virginia Tech, Blacksburg, VA 24060, USA; (J.S.B.); (A.M.B.); (T.S.)
| | - Stephanie Lansing
- Department of Environmental Science and Technology, University of Maryland, College Park, MD 20742, USA;
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22
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Rusic D, Vilovic M, Bukic J, Leskur D, Seselja Perisin A, Kumric M, Martinovic D, Petric A, Modun D, Bozic J. Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks. Life (Basel) 2021; 11:life11030220. [PMID: 33801799 PMCID: PMC8000815 DOI: 10.3390/life11030220] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 12/23/2022] Open
Abstract
The net effect of the coronavirus disease 2019 (COVID-19) pandemic and the response to it on the emergence of antimicrobial resistance is yet unknown. Positive impacts on the spread of multiresistant pathogens and infections in general may be observed with the implementation of general preventative measures for the spread of infectious disease such as social distancing, reduced travel and increased personal hygiene. This pandemic has accelerated the development of novel technologies, such as mRNA vaccines, that may be used to fight other diseases. These should be capitalized upon to manage the ongoing antimicrobial resistance pandemic in the background. However, it is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rates of inappropriate antimicrobial prescribing, the high use of biocides and the interruption of treatment for other conditions. Clinical uncertainty driven by the lack of effective diagnostics and practice of telemedicine may have driven the inappropriate use of antimicrobials. As pathogens know no borders, increased focus is needed for infectious diseases still threatening low- and middle-income countries such as tuberculosis. Stewardship measures for future outbreaks should stress the importance of social distancing and hand washing but discourage the overuse of disinfectants and antimicrobials that are not proven effective.
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Affiliation(s)
- Doris Rusic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Ana Seselja Perisin
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Dinko Martinovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Ana Petric
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
- Split-Dalmatia County Pharmacy, Kneza Ljudevita Posavskog 12 b, 21 000 Split, Croatia
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
- Correspondence:
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23
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Grau S, Echeverria-Esnal D, Gómez-Zorrilla S, Navarrete-Rouco ME, Masclans JR, Espona M, Gracia-Arnillas MP, Duran X, Comas M, Horcajada JP, Ferrández O. Evolution of Antimicrobial Consumption During the First Wave of COVID-19 Pandemic. Antibiotics (Basel) 2021; 10:antibiotics10020132. [PMID: 33573070 PMCID: PMC7911440 DOI: 10.3390/antibiotics10020132] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The first wave of COVID-19 pandemic may have significantly impacted antimicrobial consumption in hospitals. The objective of this study was to assess the evolution of antimicrobial consumption during this period. Methods: A retrospective quasi-experimental before–after study was conducted in a Spanish tertiary care hospital. The study compared two periods: pre-pandemic, from January 2018 to February 2020, and during the COVID-19 pandemic from March to June 2020. Antimicrobial consumption was analyzed monthly as defined daily doses (DDD)/100 bed-days and overall hospital and ICU consumption were evaluated. Results: An increase in the hospital consumption was noticed. Although only ceftaroline achieved statistical significance (p = 0.014), a rise was observed in most of the studied antimicrobials. A clear temporal pattern was detected. While an increase in ceftriaxone and azithromycin was observed during March, an increment in the consumption of daptomycin, carbapenems, linezolid, ceftaroline, novel cephalosporin/β-lactamase inhibitors or triazoles during April–May was noticed. In the ICU, these findings were more evident, namely ceftriaxone (p = 0.029), carbapenems (p = 0.002), daptomycin (p = 0.002), azithromycin (p = 0.030), and linezolid (p = 0.011) but followed a similar temporal pattern. Conclusion: An increase in the antimicrobial consumption during the first wave of COVID-19 pandemic was noticed, especially in the ICU. Availability of updated protocols and antimicrobial stewardship programs are essential to optimize these outcomes.
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Affiliation(s)
- Santiago Grau
- Pharmacy Department, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Hospital del Mar, Parc de Salut Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (D.E.-E.); (M.E.N.-R.); (M.E.); (O.F.)
- Medicine Department, Campus UAB, Bellaterra, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Barcelona, Spain;
- Correspondence: ; Tel.: +34-93-248-3154
| | - Daniel Echeverria-Esnal
- Pharmacy Department, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Hospital del Mar, Parc de Salut Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (D.E.-E.); (M.E.N.-R.); (M.E.); (O.F.)
| | - Silvia Gómez-Zorrilla
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS—Universitat Pompeu Fabra, Passeig Maritim 25-29, 08003 Barcelona, Spain; (S.G.-Z.); (J.P.H.)
| | - Maria Eugenia Navarrete-Rouco
- Pharmacy Department, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Hospital del Mar, Parc de Salut Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (D.E.-E.); (M.E.N.-R.); (M.E.); (O.F.)
| | - Joan Ramon Masclans
- Medicine Department, Campus UAB, Bellaterra, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Barcelona, Spain;
- Critical Care Department, GREPAC, IMIM (Mar Hospital Medical Research Institute), Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain;
| | - Merce Espona
- Pharmacy Department, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Hospital del Mar, Parc de Salut Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (D.E.-E.); (M.E.N.-R.); (M.E.); (O.F.)
| | - Maria Pilar Gracia-Arnillas
- Critical Care Department, GREPAC, IMIM (Mar Hospital Medical Research Institute), Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain;
| | - Xavier Duran
- Scientific, Statistics and Technical Department, Hospital del Mar-IMIM, Parc de Salut Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain;
| | - Merce Comas
- Epidemiology and Evaluation, Research Network on Health Services in Chronic Diseases (REDISSEC), Hospital del Mar, Parc de Salut Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain;
| | - Juan Pablo Horcajada
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS—Universitat Pompeu Fabra, Passeig Maritim 25-29, 08003 Barcelona, Spain; (S.G.-Z.); (J.P.H.)
| | - Olivia Ferrández
- Pharmacy Department, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Hospital del Mar, Parc de Salut Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (D.E.-E.); (M.E.N.-R.); (M.E.); (O.F.)
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24
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Ashiru-Oredope D, Kerr F, Hughes S, Urch J, Lanzman M, Yau T, Cockburn A, Patel R, Sheikh A, Gormley C, Chavda A, Vaghela T, Phillips C, Reid N, Brady A. Assessing the Impact of COVID-19 on Antimicrobial Stewardship Activities/Programs in the United Kingdom. Antibiotics (Basel) 2021; 10:antibiotics10020110. [PMID: 33498716 PMCID: PMC7912640 DOI: 10.3390/antibiotics10020110] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 12/16/2022] Open
Abstract
Since first identified in late 2019, the acute respiratory syndrome coronavirus (SARS-CoV2) and the resulting coronavirus disease (COVID-19) pandemic has overwhelmed healthcare systems worldwide, often diverting key resources in a bid to meet unprecedented challenges. To measure its impact on national antimicrobial stewardship (AMS) activities, a questionnaire was designed and disseminated to antimicrobialstewardship leads in the United Kingdom (UK). Most respondents reported a reduction in AMS activity with 64% (61/95) reporting that COVID-19 had a negative impact on routine AMS activities. Activities reported to have been negatively affected by the pandemic include audit, quality improvement initiatives, education, AMS meetings, and multidisciplinary working including ward rounds. However, positive outcomes were also identified, with technology being increasingly used as a tool to facilitate stewardship e.g., virtual meetings and ward rounds and increased the acceptance of using procalcitonin tests to distinguish between viral and bacterial infections. The COVID-19 pandemic has had a significant impact on the AMS activities undertaken across the UK. The long-term impact of the reduced AMS activities on incidence of AMR are not yet known. The legacy of innovation, use of technology, and increased collaboration from the pandemic could strengthen AMS in the post-pandemic era and presents opportunities for further development of AMS.
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Affiliation(s)
- Diane Ashiru-Oredope
- The Pharmacy Infection Network (PIN), United Kingdom Clinical Pharmacy Association (UKCPA), Leicester LE2 5BB, UK; (S.H.); (J.U.); (M.L.); (T.Y.); (R.P.); (A.S.); (A.C.); (T.V.)
- Correspondence:
| | - Frances Kerr
- Association of Scottish Antimicrobial Pharmacists (ASAP), Room 48, Ward 41, Regional Infectious Diseases Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; (F.K.); (A.C.)
| | - Stephen Hughes
- The Pharmacy Infection Network (PIN), United Kingdom Clinical Pharmacy Association (UKCPA), Leicester LE2 5BB, UK; (S.H.); (J.U.); (M.L.); (T.Y.); (R.P.); (A.S.); (A.C.); (T.V.)
| | - Jonathan Urch
- The Pharmacy Infection Network (PIN), United Kingdom Clinical Pharmacy Association (UKCPA), Leicester LE2 5BB, UK; (S.H.); (J.U.); (M.L.); (T.Y.); (R.P.); (A.S.); (A.C.); (T.V.)
| | - Marisa Lanzman
- The Pharmacy Infection Network (PIN), United Kingdom Clinical Pharmacy Association (UKCPA), Leicester LE2 5BB, UK; (S.H.); (J.U.); (M.L.); (T.Y.); (R.P.); (A.S.); (A.C.); (T.V.)
| | - Ting Yau
- The Pharmacy Infection Network (PIN), United Kingdom Clinical Pharmacy Association (UKCPA), Leicester LE2 5BB, UK; (S.H.); (J.U.); (M.L.); (T.Y.); (R.P.); (A.S.); (A.C.); (T.V.)
| | - Alison Cockburn
- Association of Scottish Antimicrobial Pharmacists (ASAP), Room 48, Ward 41, Regional Infectious Diseases Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; (F.K.); (A.C.)
| | - Rakhee Patel
- The Pharmacy Infection Network (PIN), United Kingdom Clinical Pharmacy Association (UKCPA), Leicester LE2 5BB, UK; (S.H.); (J.U.); (M.L.); (T.Y.); (R.P.); (A.S.); (A.C.); (T.V.)
| | - Adel Sheikh
- The Pharmacy Infection Network (PIN), United Kingdom Clinical Pharmacy Association (UKCPA), Leicester LE2 5BB, UK; (S.H.); (J.U.); (M.L.); (T.Y.); (R.P.); (A.S.); (A.C.); (T.V.)
| | - Cairine Gormley
- Northern Ireland Regional Antimicrobial Pharmacists Network, Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Antrim Area Hospital Site, Bush Road, Antrim BT41 2RL, UK; (C.G.); (A.B.)
| | - Aneeka Chavda
- The Pharmacy Infection Network (PIN), United Kingdom Clinical Pharmacy Association (UKCPA), Leicester LE2 5BB, UK; (S.H.); (J.U.); (M.L.); (T.Y.); (R.P.); (A.S.); (A.C.); (T.V.)
| | - Tejal Vaghela
- The Pharmacy Infection Network (PIN), United Kingdom Clinical Pharmacy Association (UKCPA), Leicester LE2 5BB, UK; (S.H.); (J.U.); (M.L.); (T.Y.); (R.P.); (A.S.); (A.C.); (T.V.)
| | - Ceri Phillips
- All Wales Antimicrobial Pharmacists Group, Cardiff CF10 4BZ, UK; (C.P.); (N.R.)
| | - Nicholas Reid
- All Wales Antimicrobial Pharmacists Group, Cardiff CF10 4BZ, UK; (C.P.); (N.R.)
| | - Aaron Brady
- Northern Ireland Regional Antimicrobial Pharmacists Network, Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Antrim Area Hospital Site, Bush Road, Antrim BT41 2RL, UK; (C.G.); (A.B.)
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25
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Antimicrobial Resistance in the Context of the Sustainable Development Goals: A Brief Review. Eur J Investig Health Psychol Educ 2021; 11:71-82. [PMID: 34542450 PMCID: PMC8314330 DOI: 10.3390/ejihpe11010006] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/15/2022] Open
Abstract
The reduction in infectious disease morbidity and mortality may be attributed to a variety of factors; however, improved sanitation and public health, and the introduction of vaccines and antibiotics are among the most significant. The development of antimicrobial resistance (AMR) in bacterial pathogens is an expected consequence of evolutionary adaptation to these noxious agents and the widespread use of these drugs has significantly sped up this process. Infections caused by multidrug resistant pathogens are directly associated with worse clinical outcomes, longer hospital stays, excess mortality in the affected patients and an increasing burden and costs on the healthcare infrastructure. The Sustainable Development Goals (SDGs) were published in 2015 by the United Nations to serve as a global blueprint for a better, more equitable, more sustainable life on our planet. The SDGs contextualize AMR as a global public health and societal issue; in addition, the continuing emergence of AMR may limit the attainment on many SDGs. The aim of this mini-review is to provide insight on the interface between attainment of SDGs and the clinical problem of drug resistance in bacteria.
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