The impact of the COVID-19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland.
COVID-19
antimicrobial consumption
antimicrobial resistance
antimicrobial stewardship
clinical practice
drug utilization
Journal
British journal of clinical pharmacology
ISSN: 1365-2125
Titre abrégé: Br J Clin Pharmacol
Pays: England
ID NLM: 7503323
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
04
04
2023
received:
10
12
2022
accepted:
04
05
2023
medline:
16
8
2023
pubmed:
10
5
2023
entrez:
10
5
2023
Statut:
ppublish
Résumé
To evaluate the impact of the COVID-19 pandemic on the patterns of antimicrobial use and the incidence of pathogens in primary and secondary healthcare settings in Northern Ireland. Data were collected on antibiotic use and Gram-positive and Gram-negative pathogens from primary and secondary healthcare settings in Northern Ireland for the period before (January 2015-March 2020) and during (April 2020-December 2021) the pandemic. Time series intervention analysis methods were utilized. In the hospital setting, the mean total hospital antibiotic consumption during the pandemic was 1864.5 defined daily doses (DDDs) per 1000 occupied-bed days (OBD), showing no significant change from pre-pandemic (P = .7365). During the pandemic, the use of second-generation cephalosporins, third-generation cephalosporins, co-amoxiclav and levofloxacin increased, there was a decrease in the percentage use of the hospital Access group (P = .0083) and an increase in the percentage use of Watch group (P = .0040), and the number of hospital Klebsiella oxytoca and methicillin-susceptible Staphylococcus aureus cases increased. In primary care, the mean total antibiotic consumption during the COVID-19 pandemic was 20.53 DDDs per 1000 inhabitants per day (DID), compared to 25.56 DID before the COVID-19 pandemic (P = .0071). During the pandemic, there was a decrease in the use of several antibiotic classes, an increase in the percentage use of the Reserve group (P = .0032) and an increase in the number of community-onset Pseudomonas aeruginosa cases. This study provides details of both changes in antibiotic consumption and the prevalence of infections in hospitals and primary care before and during the COVID-19 pandemic that emphasize the importance of antimicrobial stewardship in pandemic situations.
Substances chimiques
Anti-Bacterial Agents
0
Cephalosporins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2851-2866Informations de copyright
© 2023 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
Références
Murray CJL, Ikuta KS, Sharara F, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655. doi:10.1016/S0140-6736(21)02724-0
O'Neill J. Antimicrobial resistance: Tackling a crisis for the health and wealth of nations. Accessed September 20, 2022. https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf
Jirjees FJ, Al-Obaidi HJ, Sartaj M, et al. Antibiotic use and resistance in hospitals: time-series analysis strategy for determining and prioritising interventions. Accessed February 9, 2022. https://hospitalpharmacyeurope.com/news/reviews-research/antibiotic-use-and-resistance-in-hospitals-time-series-analysis-strategy-for-determining-and-prioritising-interventions/
Aldeyab M, López-Lozano J-M, Gould IM. Global antibiotics use and resistance. In: Babar Z-U-D, ed. Global Pharmaceutical Policy. Springer Singapore; 2020:331-344. doi:10.1007/978-981-15-2724-1_13
Antimicrobial Resistance Division NAPaMaE. Global action plan on antimicrobial resistance. 2022. https://www.who.int/publications/i/item/9789241509763
Antimicrobial resistance in the age of COVID-19. Nat Microbiol. 2020;5(6):779. doi:10.1038/s41564-020-0739-4
Sharland M, Cappello B, Ombajo LA, et al. The WHO AWaRe Antibiotic Book: providing guidance on optimal use and informing policy. Lancet Infect Dis. 2022;22(11):1528-1530. doi:10.1016/s1473-3099(22)00683-1
Shbaklo N, Lupia T, De Rosa FG, Corcione S. Infection control in the era of COVID-19: a narrative review. Antibiotics. 2021;10(10):1244. doi:10.3390/antibiotics10101244
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. 2022;11(2):244. doi:10.3390/antibiotics11020244
Huttner BD, Catho G, Pano-Pardo JR, Pulcini C, Schouten J. COVID-19: don't neglect antimicrobial stewardship principles! Clin Microbiol Infect. 2020;26(7):808-810. doi:10.1016/j.cmi.2020.04.024
Zhang J, Zhou L, Yang Y, Peng W, Wang W, Chen X. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics. Lancet Respir Med. 2020;8(3):e11-e12. doi:10.1016/s2213-2600(20)30071-0
Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425-434. doi:10.1016/s1473-3099(20)30086-4
Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976
Nakitanda AO, Karlsson P, Löfling L, Cesta CE, Odsbu I. Antimicrobial use in Sweden during the COVID-19 pandemic: prescription fill and inpatient care requisition patterns. BMC Infect Dis. 2022;22(1):492. doi:10.1186/s12879-022-07405-3
Hsu J. How covid-19 is accelerating the threat of antimicrobial resistance. BMJ. 2020;369:m1983. doi:10.1136/bmj.m1983
Afshinnekoo E, Bhattacharya C, Burguete-García A, et al. COVID-19 drug practices risk antimicrobial resistance evolution. Lancet Microbe. 2021;2(4):e135-e136. doi:10.1016/s2666-5247(21)00039-2
WHO. Coronavirus disease (COVID-19). Accessed February 9, 2022. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19
Rawson TM, Moore LSP, Zhu N, et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020;71(9):2459-2468. doi:10.1093/cid/ciaa530
Youngs J, Wyncoll D, Hopkins P, Arnold A, Ball J, Bicanic T. Improving antibiotic stewardship in COVID-19: bacterial co-infection is less common than with influenza. J Infect. 2020;81(3):e55-e57. doi:10.1016/j.jinf.2020.06.056
Khan S, Hasan SS, Bond SE, Conway BR, Aldeyab MA. Antimicrobial consumption in patients with COVID-19: a systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2022;20(5):749-772. doi:10.1080/14787210.2022.2011719
Langford BJ, So M, Simeonova M, et al. Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis. Lancet Microbe. 2023;4(3):e179-e191. doi:10.1016/s2666-5247(22)00355-x
Ono A, Koizumi R, Tsuzuki S, et al. Antimicrobial use fell substantially in Japan in 2020-the COVID-19 pandemic may have played a role. Int J Infect Dis. 2022;119:13-17. doi:10.1016/j.ijid.2022.03.019
Grau S, Echeverria-Esnal D, Gómez-Zorrilla S, et al. Evolution of antimicrobial consumption during the first wave of COVID-19 pandemic. Antibiotics. 2021;10(2):132. doi:10.3390/antibiotics10020132
Hamidi AA, Yılmaz Ş. Antibiotic consumption in the hospital during COVID-19 pandemic and distribution of bacterial agents and antimicrobial resistance: a single-center study. J Surg Med. 2021;5(2):124-127. doi:10.28982/josam.834535
Gonzalez-Zorn B. Antibiotic use in the COVID-19 crisis in Spain. Clin Microbiol Infect. 2021;27(4):646-647. doi:10.1016/j.cmi.2020.09.055
Al-Azzam S, Mhaidat NM, Banat HA, et al. An assessment of the impact of coronavirus disease (COVID-19) pandemic on national antimicrobial consumption in Jordan. Antibiotics. 2021;10(6):690. doi:10.3390/antibiotics10060690
Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-e77. doi:10.1093/cid/ciw118
Mazdeyasna H, Nori P, Patel P, et al. Antimicrobial stewardship at the core of COVID-19 response efforts: implications for sustaining and building programs. Curr Infect Dis Rep. 2020;22(9):23. doi:10.1007/s11908-020-00734-x
Spernovasilis NA, Kofteridis DP. COVID-19 and antimicrobial stewardship: what is the interplay? Infect Control Hosp Epidemiol. 2021;42(3):378-379. doi:10.1017/ice.2020.246
De Rosa FG, Palazzo A, Rosso T, et al. Risk factors for mortality in COVID-19 hospitalized patients in Piedmont, Italy: results from the multicenter, regional, CORACLE Registry. J Clin Med. 2021;10(9):1951. doi:10.3390/jcm10091951
Karami M. Surveillance systems for nosocomial infections: methods and challenges. Infect Control Hosp Epidemiol. 2016;37(2):237-238. doi:10.1017/ice.2015.292
Khatri A, Malhotra P, Izard S, et al. Hospital-acquired bloodstream infections in patients hospitalized with severe acute respiratory syndrome coronavirus 2 infection (coronavirus disease 2019): association with immunosuppressive therapies. Open Forum Infect Dis. 2021;8(7):ofab339. doi:10.1093/ofid/ofab339
Grasselli G, Scaravilli V, Mangioni D, et al. Hospital-acquired infections in critically ill patients with COVID-19. Chest. 2021;160(2):454-465. doi:10.1016/j.chest.2021.04.002
Pérez-Granda MJ, Carrillo CS, Rabadán PM, et al. Increase in the frequency of catheter-related bloodstream infections during the COVID-19 pandemic: a plea for control. J Hosp Infect. 2022;119:149-154. doi:10.1016/j.jhin.2021.09.020
Weiner-Lastinger LM, Pattabiraman V, Konnor RY, et al. The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: a summary of data reported to the National Healthcare Safety Network. Infect Control Hosp Epidemiol. 2022;43(1):12-25. doi:10.1017/ice.2021.362
Barbaric J, Kuchukhidze G, Seguy N, et al. Surveillance and epidemiology of syphilis, gonorrhoea and chlamydia in the non-European Union countries of the World Health Organization European Region, 2015 to 2020. Euro Surveill. 2022;27(8):2100197. doi:10.2807/1560-7917.Es.2022.27.8.2100197
Grau S, Hernández S, Echeverría-Esnal D, et al. Antimicrobial consumption among 66 acute care hospitals in Catalonia: impact of the COVID-19 pandemic. Antibiotics. 2021;10(8):943. doi:10.3390/antibiotics10080943
Meschiari M, Onorato L, Bacca E, et al. Long-term impact of the COVID-19 pandemic on in-hospital antibiotic consumption and antibiotic resistance: a time series analysis (2015-2021). Antibiotics. 2022;11(6):826. doi:10.3390/antibiotics11060826
Alzueta N, Echeverría A, García P, et al. Impact of COVID-19 pandemic in antibiotic consumption in Navarre (Spain): an interrupted time series analysis. Antibiotics. 2023;12(2):318. doi:10.3390/antibiotics12020318
Russell CD, Fairfield CJ, Drake TM, et al. Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study. Lancet Microbe. 2021;2(8):e354-e365. doi:10.1016/s2666-5247(21)00090-2
Guisado-Gil AB, Infante-Domínguez C, Peñalva G, et al. Impact of the COVID-19 pandemic on antimicrobial consumption and hospital-acquired candidemia and multidrug-resistant bloodstream infections. Antibiotics. 2020;9(11):816. doi:10.3390/antibiotics9110816
NISRA. 2020 mid year population estimates for Northern Ireland. Accessed February 9, 2022. https://www.nisra.gov.uk/publications/2020-mid-year-population-estimates-northern-ireland
BSO. GP Prescribing Data. Accessed September 9, 2022. https://hscbusiness.hscni.net/services/3178.htm
NICE guideline [NG173]. COVID-19 rapid guideline: antibiotics for pneumonia in adults in hospital. Accessed March 28, 2023. https://www.nice.org.uk/guidance/ng173
Metan G, Demir Çuha M, Hazirolan G, et al. The impact of COVID-19 pandemic on nosocomial multidrug-resistant bacterial bloodstream infections and antibiotic consumption in a tertiary care hospital. GMS Hyg Infect Control. 2022;17:Doc15. doi:10.3205/dgkh000418
Silva ARO, Salgado DR, Lopes LPN, Castanheira D, Emmerick ICM, Lima EC. Increased use of antibiotics in the intensive care unit during coronavirus disease (COVID-19) pandemic in a Brazilian hospital. Front Pharmacol. 2021;12:778386. doi:10.3389/fphar.2021.778386
Shbaklo N, Corcione S, Vicentini C, et al. An observational study of MDR hospital-acquired infections and antibiotic use during COVID-19 pandemic: a call for antimicrobial stewardship programs. Antibiotics. 2022;11(5):695. doi:10.3390/antibiotics11050695
WHO. 2021 AWaRe classification: WHO access, watch, reserve, classification of antibiotics for evaluation and monitoring of use. Accessed March 20, 2023. https://www.who.int/publications/i/item/2021-aware-classification
Khan S, Bond SE, Bakhit M, et al. COVID-19 mixed impact on hospital antimicrobial stewardship activities: a qualitative study in UK-based hospitals. Antibiotics. 2022;11(11):1600. doi:10.3390/antibiotics11111600
WHO. Adopt AWaRe: handle antibiotics with care. Accessed November 10, 2022. https://adoptaware.org/
Department of Agriculture EaRA. Changing the Culture 2019-2024-One Health. Accessed September 20, 2022. https://www.daera-ni.gov.uk/sites/default/files/publications/daera/One-Health-Changing%20the%20Culture-2019-2024%20Final%20Proof.pdf
Zay Ya K, Win PTN, Bielicki J, Lambiris M, Fink G. Association between antimicrobial stewardship programs and antibiotic use globally: a systematic review and meta-analysis. JAMA Netw Open. 2023;6(2):e2253806. doi:10.1001/jamanetworkopen.2022.53806
Spernovasilis N, Kritsotakis EI, Mathioudaki A, et al. A carbapenem-focused antimicrobial stewardship programme implemented during the COVID-19 pandemic in a setting of high endemicity for multidrug-resistant Gram-negative bacteria. J Antimicrob Chemother. 2023;78(4):1000-1008. doi:10.1093/jac/dkad035
Conlon-Bingham GM, Hedderwick SA, McKeating CM, et al. Preserving last resort antibiotics: a meropenem reduction strategy. Infect Control Hosp Epidemiol. 2022;43(10):1516-1517. doi:10.1017/ice.2021.276
Castro-Lopes A, Correia S, Leal C, et al. Increase of antimicrobial consumption in a tertiary care hospital during the first phase of the COVID-19 pandemic. Antibiotics. 2021;10(7):778. doi:10.3390/antibiotics10070778
Rose AN, Baggs J, Wolford H, et al. Trends in antibiotic use in United States hospitals during the coronavirus disease 2019 pandemic. Open Forum Infect Dis. 2021;8(6):ofab236. doi:10.1093/ofid/ofab236
Bogdanić N, Močibob L, Vidović T, Soldo A, Begovać J. Azithromycin consumption during the COVID-19 pandemic in Croatia, 2020. PLoS ONE. 2022;17(2):e0263437. doi:10.1371/journal.pone.0263437
Polemis M, Mandilara G, Pappa O, et al. COVID-19 and antimicrobial resistance: data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance-WHONET-Greece (January 2018-March 2021). Life. 2021;11(10):996. doi:10.3390/life11100996
Pasquini Z, Barocci I, Brescini L, et al. Bloodstream infections in the COVID-19 era: results from an Italian multi-centre study. Int J Infect Dis. 2021;111:31-36. doi:10.1016/j.ijid.2021.07.065
Macera M, Onorato L, Calò F, et al. The impact of the SARS-Cov2 pandemic on a persuasive educational antimicrobial stewardship program in a university hospital in Southern Italy: a pre-post study. Antibiotics. 2021;10(11):1405. doi:10.3390/antibiotics10111405
UK Health Security Agency. Annual Epidemiological Commentary: Gram-negative, MRSA, MSSA bacteraemia and C. difficile infections, up to and including financial year 2021 to 2022. Accessed March 28, 2023. https://www.gov.uk/government/statistics/mrsa-mssa-and-e-coli-bacteraemia-and-c-difficile-infection-annual-epidemiological-commentary/annual-epidemiological-commentary-gram-negative-mrsa-mssa-bacteraemia-and-c-difficile-infections-up-to-and-including-financial-year-2021-to-2022#bacteraemia-caused-by-gram-negative-organisms
Ng QX, Ong NY, Lee DYX, et al. Trends in Pseudomonas aeruginosa (P. aeruginosa) bacteremia during the COVID-19 pandemic: a systematic review. Antibiotics. 2023;12(2):409. doi:10.3390/antibiotics12020409
de Carvalho Hessel Dias VM, Tuon F, de Jesus CP, Telles JP, Fortaleza C, Pellegrino Baena C. Trend analysis of carbapenem-resistant Gram-negative bacteria and antimicrobial consumption in the post-COVID-19 era: an extra challenge for healthcare institutions. J Hosp Infect. 2022;120:43-47. doi:10.1016/j.jhin.2021.11.011
Stone PW, Pogorzelska M, Kunches L, Hirschhorn LR. Hospital staffing and health care-associated infections: a systematic review of the literature. Clin Infect Dis. 2008;47(7):937-944. doi:10.1086/591696
Colliers A, De Man J, Adriaenssens N, et al. Antibiotic prescribing trends in Belgian out-of-hours primary care during the COVID-19 pandemic: observational study using routinely collected health data. Antibiotics. 2021;10(12):1488. doi:10.3390/antibiotics10121488
Andrews A, Bou-Antoun S, Guy R, Brown CS, Hopkins S, Gerver S. Respiratory antibacterial prescribing in primary care and the COVID-19 pandemic in England, winter season 2020-21. J Antimicrob Chemother. 2022;77(3):799-802. doi:10.1093/jac/dkab443
Gillies MB, Burgner DP, Ivancic L, et al. Changes in antibiotic prescribing following COVID-19 restrictions: lessons for post-pandemic antibiotic stewardship. Br J Clin Pharmacol. 2022;88(3):1143-1151. doi:10.1111/bcp.15000
Silva TM, Estrela M, Gomes ER, et al. The impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care: a nationwide, quasi-experimental approach. Antibiotics. 2021;10(9):1040. doi:10.3390/antibiotics10091040
Rezel-Potts E, L'Esperance V, Gulliford MC. Antimicrobial stewardship in the UK during the COVID-19 pandemic: a population-based cohort study and interrupted time-series analysis. Br J Gen Pract. 2021;71(706):e331-e338. doi:10.3399/bjgp.2020.1051
Zhu N, Aylin P, Rawson T, Gilchrist M, Majeed A, Holmes A. Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves. Clin Microbiol Infect. 2021;27(5):762-768. doi:10.1016/j.cmi.2021.02.007
Malcolm W, Seaton RA, Haddock G, et al. Impact of the COVID-19 pandemic on community antibiotic prescribing in Scotland. JAC Antimicrob Resist. 2020;2(4):dlaa105. doi:10.1093/jacamr/dlaa105
NICE guideline [NG165]. COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community. Accessed March 20, 2023. https://www.nice.org.uk/guidance/ng165
NICE guideline [NG191]. COVID-19 rapid guideline: managing COVID-19. Accessed March 20, 2023. https://www.nice.org.uk/guidance/ng191