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Ruzsa R, Benkő R, Hambalek H, Papfalvi E, Csupor D, Nacsa R, Csatordai M, Soós G, Hajdú E, Matuz M. Hospital Antibiotic Consumption before and during the COVID-19 Pandemic in Hungary. Antibiotics (Basel) 2024; 13:102. [PMID: 38275331 PMCID: PMC10812576 DOI: 10.3390/antibiotics13010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010-2021 period. Classifications and calculations were performed according to the WHO ATC/DDD index and expressed as DDD per 1000 inhabitants and per day (DID), DDD per 100 patient-days (DHPD) and DDD/discharge. A linear regression (trend analysis) was performed for the pre-COVID years (2010-2019) and a prediction interval was set up to assess whether the pandemic years' observed utilisation fit in. Antibiotic utilisation was constant in DID before and during the pandemic (2019: 1.16; 2020: 1.21), while we observed a substantial increase in antibiotic use when expressed in DDD per 100 patient-days (2019: 23.3, 2020: 32.2) or DDD/discharge (2019: 1.83, 2020: 2.45). The observed utilisation level of penicillin combinations; first-, third- and fourth-generation cephalosporins; carbapenems; glycopeptides; nitroimidazoles and macrolides exceeded the predicted utilisation values in both pandemic years. Before the pandemic, co-amoxiclav headed the top list of antibiotic use, while during the pandemic, ceftriaxone became the most widely used antibiotic. Azithromycin moved up substantially on the top list of antibiotic use, with a 397% increase (2019: 0.45; 2020: 2.24 DHPD) in use. In summary, the pandemic had a major impact on the scale and pattern of hospital antibiotic use in Hungary.
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Affiliation(s)
- Roxána Ruzsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Ria Benkő
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
- Department of Emergency Medicine, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Helga Hambalek
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Erika Papfalvi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- Department of Emergency Medicine, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- Institute of Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Róbert Nacsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Márta Csatordai
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
| | - Edit Hajdú
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, 6725 Szeged, Hungary;
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
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Fésüs A, Matuz M, Papfalvi E, Hambalek H, Ruzsa R, Tánczos B, Bácskay I, Lekli I, Illés Á, Benkő R. Evaluation of the Diagnosis and Antibiotic Prescription Pattern in Patients Hospitalized with Urinary Tract Infections: Single-Center Study from a University-Affiliated Hospital. Antibiotics (Basel) 2023; 12:1689. [PMID: 38136723 PMCID: PMC10741002 DOI: 10.3390/antibiotics12121689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
UTIs (urinary tract infections) are common bacterial infections with a non-negligible hospitalization rate. The diagnosis of UTIs remains a challenge for prescribers and a common source of misdiagnosis. This retrospective observational study aimed to evaluate whether recorded diagnosis by clinicians and empirical antibiotic therapy met the EAU (European Association of Urology) guideline in patients hospitalized with UTI. The study was conducted at an internal medicine unit of a tertiary care medical center in Hungary. The diagnosis was assessed based on clinical presentation, physical examination, and laboratory (including microbiological) results, considering all the potential risk factors. Diagnosis was considered misdiagnosis when not confirmed by clinical presentation or clinical signs and symptoms. Evaluation of empirical antibiotic therapy was performed only for confirmed UTIs. Empirical treatment was considered guideline-adherent when complying with the relevant recommendations. Out of 185 patients, 41.6% failed to meet EAU-based UTI diagnosis criteria, of which 27.6% were misdiagnosed and 14.1% were ABU (asymptomatic bacteriuria). The diagnosis of urosepsis recorded at admission (9.7%, 18/185) was not confirmed either by clinical or microbiological tests in five (5/18) cases. The initial empirical therapies for UTI showed a relatively low rate (45.4%) of guideline adherence regarding agent selection. The most common guideline-non-adherent therapies were combinations with metronidazole (16.7%). Dosage appropriateness assessments showed a guideline adherence rate of 36.1%, and underdosing due to high body weight was common (9.3%). Overall (agent, route of administration, dose, duration) guideline adherence was found to be substantially low (10.2%). We found a relatively high rate of misdiagnosed UTIs. Written protocols on the ward may be crucial in reducing misdiagnosis and in optimizing antibiotic use.
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Affiliation(s)
- Adina Fésüs
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (B.T.); (I.L.)
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary;
- Institute of Healthcare Industry, University of Debrecen, H-4032 Debrecen, Hungary
| | - Mária Matuz
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Erika Papfalvi
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
- Department of Emergency Medicine, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Helga Hambalek
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
| | - Roxána Ruzsa
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
| | - Bence Tánczos
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (B.T.); (I.L.)
| | - Ildikó Bácskay
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary;
- Institute of Healthcare Industry, University of Debrecen, H-4032 Debrecen, Hungary
| | - István Lekli
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (B.T.); (I.L.)
| | - Árpád Illés
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Ria Benkő
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
- Department of Emergency Medicine, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
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Hambalek H, Matuz M, Ruzsa R, Engi Z, Visnyovszki Á, Papfalvi E, Hajdú E, Doró P, Viola R, Soós G, Csupor D, Benko R. Impact of the COVID-19 Pandemic on Ambulatory Care Antibiotic Use in Hungary: A Population-Based Observational Study. Antibiotics (Basel) 2023; 12:970. [PMID: 37370289 DOI: 10.3390/antibiotics12060970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015-December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, -26.3%), and quinolones (J01M, -36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year's monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods' monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged.
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Affiliation(s)
- Helga Hambalek
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Roxána Ruzsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Zsófia Engi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Ádám Visnyovszki
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Erika Papfalvi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Edit Hajdú
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Péter Doró
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Réka Viola
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Ria Benko
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
- Emergency Department, Albert Szent-Györgyi Health Centre, University of Szeged, Semmelweis Street 6, 6725 Szeged, Hungary
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Fésüs A, Benkő R, Matuz M, Engi Z, Ruzsa R, Hambalek H, Illés Á, Kardos G. Impact of Guideline Adherence on Outcomes in Patients Hospitalized with Community-Acquired Pneumonia (CAP) in Hungary: A Retrospective Observational Study. Antibiotics (Basel) 2022; 11:antibiotics11040468. [PMID: 35453219 PMCID: PMC9026550 DOI: 10.3390/antibiotics11040468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/10/2022] Open
Abstract
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. This retrospective observational study evaluated the antibiotic prescription patterns and associations between guideline adherence and outcomes in patients hospitalized with CAP in Hungary. Main outcome measures were adherence to national and international CAP guidelines (agent choice, dose) when using empirical antibiotics, antibiotic exposure, and clinical outcomes. Demographic and clinical characteristics of patients with CAP in the 30-day mortality and 30-day survival groups were compared. Fisher’s exact test and t-test were applied to compare categorical and continuous variables, respectively. Adherence to the national CAP guideline for initial empirical therapies was 30.61% (45/147) for agent choice and 88.89% (40/45) for dose. Average duration of antibiotic therapy for CAP was 7.13 ± 4.37 (mean ± SD) days, while average antibiotic consumption was 11.41 ± 8.59 DDD/patient (range 1−44.5). Adherence to national guideline led to a slightly lower 30-day mortality rate than guideline non-adherence (15.56% vs. 16.67%, p > 0.05). In patients aged ≥ 85 years, 30-day mortality was 3 times higher than in those aged 65−84 years (30.43% vs. 11.11%). A significant difference was found between 30-day non-survivors and 30-day survivors regarding the average CRP values on admission (177.28 ± 118.94 vs. 112.88 ± 93.47 mg/L, respectively, p = 0.006) and CCI score (5.71 ± 1.85 and 4.67 ± 1.83, p = 0.012). We found poor adherence to the national and international CAP guidelines in terms of agent choice. In addition, high CRP values on admission were markedly associated with higher mortality in CAP.
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Affiliation(s)
- Adina Fésüs
- Central Clinical Pharmacy, Clinical Center, University of Debrecen, H-4032 Debrecen, Hungary;
- Department of Pharmacodynamics, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, H-4032 Debrecen, Hungary
- Health Industry Competence Centre, University of Debrecen, H-4032 Debrecen, Hungary
| | - Ria Benkő
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (R.B.); (M.M.); (Z.E.); (R.R.); (H.H.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
- Department of Emergency Medicine, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Mária Matuz
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (R.B.); (M.M.); (Z.E.); (R.R.); (H.H.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Zsófia Engi
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (R.B.); (M.M.); (Z.E.); (R.R.); (H.H.)
| | - Roxána Ruzsa
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (R.B.); (M.M.); (Z.E.); (R.R.); (H.H.)
| | - Helga Hambalek
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (R.B.); (M.M.); (Z.E.); (R.R.); (H.H.)
| | - Árpád Illés
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Gábor Kardos
- Department of Metagenomics, University of Debrecen, H-4032 Debrecen, Hungary
- Correspondence:
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