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Chan XHS, O'Connor CJ, Martyn E, Clegg AJ, Choy BJK, Soares AL, Shulman R, Stone NRH, De S, Bitmead J, Hail L, Brealey D, Arulkumaran N, Singer M, Wilson APR. Comparison of Antibiotic Use between the First Two Waves of COVID-19 in an Intensive Care Unit at a London Tertiary Centre: reducing broad-spectrum antimicrobial use did not adversely affect mortality. J Hosp Infect 2022; 124:37-46. [PMID: 35339638 PMCID: PMC8940720 DOI: 10.1016/j.jhin.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/22/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic increased the use of broad-spectrum antibiotics due to diagnostic uncertainty, particularly in critical care. Multiprofessional communication became more difficult, weakening stewardship activities. AIM To determine changes in bacterial co-/secondary infections and antibiotics used in COVID-19 patients in critical care, and mortality rates, between the first and second waves. METHODS Prospective audit comparing bacterial co-/secondary infections and their treatment during the first two waves of the pandemic in a single centre teaching hospital ICU. Data on demographics, daily antibiotic use, clinical outcomes, and culture results in patients diagnosed with COVID-19 infection were collected over 11 months. FINDINGS From 9/3/20 to 2/9/20 (Wave 1), there were 156 patients and between 3/9/20 and 1/2/21 (Wave 2) there were 235 patients with COVID-19 infection admitted to intensive care. No significant difference was seen in mortality or positive blood culture rates between the two waves. The proportion of patients receiving antimicrobial therapy (93.0% vs 81.7%; p<0.01), and the duration of meropenem use (median (interquartile range): 5 (2-7) vs 3 (2-5) days; p=0.01) was lower in Wave 2. However, the number of patients with respiratory isolates of Pseudomonas aeruginosa (4/156 vs 21/235; p<0.01) and bacteraemia from a respiratory source (3/156 vs 20/235 p<0.01) increased in Wave 2, associated with an outbreak of infection. There was no significant difference between waves with respect to isolation of other pathogens. CONCLUSIONS Reduced broad spectrum antimicrobial use in the second wave of COVID-19 compared with the first wave was not associated with significant change in mortality.
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Affiliation(s)
- X H S Chan
- Department of Clinical Microbiology, University College London NHS Foundation Trust, London, United Kingdom; Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C J O'Connor
- Department of Clinical Microbiology, University College London NHS Foundation Trust, London, United Kingdom
| | - E Martyn
- Department of Clinical Microbiology, University College London NHS Foundation Trust, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - A J Clegg
- Department of Clinical Microbiology, University College London NHS Foundation Trust, London, United Kingdom
| | - B J K Choy
- Department of Clinical Microbiology, University College London NHS Foundation Trust, London, United Kingdom
| | - A L Soares
- Department of Clinical Microbiology, University College London NHS Foundation Trust, London, United Kingdom
| | - R Shulman
- Department of Critical Care, University College London NHS Foundation Trust, London, United Kingdom; Department of Pharmacy, CMORE, University College London NHS Foundation Trust, London, United Kingdom
| | - N R H Stone
- Department of Clinical Microbiology, University College London NHS Foundation Trust, London, United Kingdom
| | - S De
- Department of Clinical Microbiology, University College London NHS Foundation Trust, London, United Kingdom
| | - J Bitmead
- Department of Infection Control, University College London NHS Foundation Trust, London, United Kingdom
| | - L Hail
- Department of Infection Control, University College London NHS Foundation Trust, London, United Kingdom
| | - D Brealey
- Department of Critical Care, University College London NHS Foundation Trust, London, United Kingdom; Bloomsbury Institute for Intensive Care Medicine, University College London, London, United Kingdom
| | - N Arulkumaran
- Department of Critical Care, University College London NHS Foundation Trust, London, United Kingdom; Bloomsbury Institute for Intensive Care Medicine, University College London, London, United Kingdom
| | - M Singer
- Department of Critical Care, University College London NHS Foundation Trust, London, United Kingdom; Bloomsbury Institute for Intensive Care Medicine, University College London, London, United Kingdom
| | - A P R Wilson
- Department of Clinical Microbiology, University College London NHS Foundation Trust, London, United Kingdom.
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Hyde BG, Thompson JG, Withers RL, FitzGerald JG, Stewart AM, Bevan DJM, Anderson JS, Bitmead J, Paterson MS. The room-temperature structure of the ∼90-K superconducting phase YBa2Cu3O7−x. Nature 1987. [DOI: 10.1038/327402a0] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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