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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: 55] [Impact Index Per Article: 18.3] [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: 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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Urbina O, Ferrández O, Grau S, Luque S, Mojal S, Marin-Casino M, Mateu-de-Antonio J, Carmona A, Conde-Estévez D, Espona M, González E, Riu M, Salas E. Design of a score to identify hospitalized patients at risk of drug-related problems. Pharmacoepidemiol Drug Saf 2014; 23:923-32. [DOI: 10.1002/pds.3634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/30/2014] [Accepted: 04/02/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Olatz Urbina
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Olivia Ferrández
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Santiago Grau
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
- Pharmacy Department; Hospital Universitari del Mar, Universitat Autònoma de Barcelona; Barcelona Spain
| | - Sonia Luque
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Sergi Mojal
- Department of Statistics; Hospital Universitari del Mar; Barcelona Spain
| | | | | | - Alexia Carmona
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | | | - Merce Espona
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Elena González
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
| | - Marta Riu
- Department of Epidemiology and Health Services Evaluation; Hospital Universitari del Mar; Barcelona Spain
| | - Esther Salas
- Pharmacy Department; Hospital Universitari del Mar; Barcelona Spain
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Abstract
Enfuvirtide or T-20 is the first drug approved by the FDA and the EMEA within the group of fusion inhibitors. Its mechanism of action is based on the blockade of the entry of the HIV to the body cells. Enfuvirtide is recommended in combination with other antiretroviral drugs for the treatment of patients infected by HIV that have developed resistance or intolerance to other prior antiretroviral therapies. Clinical trials have shown the effectiveness and safety of the treatment with this drug. Side effects most commonly reported are local reactions in the injection site. Enfuvirtide contributes to increase the therapeutic arsenal available for the management of the HIV infection, providing rescue therapy for patients in which prior treatments have failed.
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Affiliation(s)
- M Espona
- Servicio de Farmacia, IMAS, Hospital del Mar, Passeig Marítim 25, 08003 Barcelona, Spain
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Knobel H, Guelar A, Carmona A, Espona M, González A, López-Colomés JL, Saballs P, Gimeno JL, Díez A. Virologic outcome and predictors of virologic failure of highly active antiretroviral therapy containing protease inhibitors. AIDS Patient Care STDS 2001; 15:193-9. [PMID: 11359661 DOI: 10.1089/10872910151133729] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this observational single-center cohort study outside the clinical trial setting, outcome and predictors of virologic failure of highly active antiretroviral therapy (HAART) containing a protease inhibitor were evaluated in human immunodeficiency (HIV)-infected persons. The study population consisted of 807 protease inhibitor-naive HIV-seropositive patients who initiated antiretroviral therapy with reverse transcriptase inhibitors and protease inhibitors (indinavir, nelfinavir, ritonavir) between January 1997 and January 1999. Demographic variable, plasma HIV-1 RNA levels, CD4+ T-cell count, adverse drug reactions, and adherence to HAART were assessed. Virologic treatment response was defined as a decrease in plasma HIV-1 RNA load from baseline to below 500 copies per milliliter after 12 months of therapy. Levels of HIV-1 RNA were undetectable in 43% of patients at 12 months. Factors associated with failure to suppress viral load included age 40 years or younger, baseline CD4+ T cell count less than 200 x 10(6) per liter baseline viral load greater than 4.3 log(10) per milliliter, and non-adherence to HAART. After adjustment by logistic regression, non-adherence was the only statistically significant variable associated with virologic failure (odds ratio 0.38, 95% confidence interval 0.21 to 0.67). Unselected patients in whom protease inhibitor is started in a usual clinical setting achieve viral suppression less frequently than do patients in controlled clinical trials. Failure to adherence to HAART was the strongest predictor of virologic failure.
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Affiliation(s)
- H Knobel
- Department of Internal Medicine-Infectious Diseases, Autonomous University of Barcelona, Barcelona, Spain.
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