Evolution of Antimicrobial Consumption During the First Wave of COVID-19 Pandemic

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.

Keywords: COVID-19; antibiotic consumption; antimicrobial resistance; antimicrobial stewardship; defined daily doses (DDD).

Figure 1

Evolution of drug consumption in hospital expressed in defined daily doses (DDD)/100 bed-days. (a) Ceftaroline: β-change 11.771, p = 0.014; (b) azithromycin: β-change 63.129, p = 0.085; (c) ceftriaxone: β-change 18.390, p = 0.692; (d) carbapenems: β-change −12.714, p = 0.592; (e) triazoles: β-change 17.601, p = 0.333; (f) linezolid β-change 13.725, p = 0.211; (g) liposomal amphotericin B: β-change −2.692, p = 0.463; (h) novel cephalosporins/β-lactamase inhibitors: β-change −4.064, p = 0.491; (i) daptomycin: β-change 11.147, p= 0.644; (j) vancomycin: β-change −7.435, p = 0.705; (k) echinocandins: β-change −20.550, p = 0.117.

Figure 2

Evolution of drug consumption in the expanded-intensive care unit (ICU) expressed in defined daily doses (DDD)/100 bed-days. (a) Ceftriaxone: β-change 21.501, p = 0.029; (b) carbapenems: β-change 26.103, p = 0.002; (c) daptomycin: β-change 18.093, p = 0.002; (d) azithromycin: β-change 19.422, p = 0.030; (e) linezolid: β-change 9.183, p = 0.011; (f) triazoles: β-change 7.939, p = 0.089; (g) vancomycin: β-change 1.816, p = 0.079; (h) novel cephalosporins/β-lactamase inhibitors: β-change −1.698, p = 0.225; (i) echinocandins: β-change −1.525, p = 0.626; (j) liposomal amphotericin B: β-change −0.311, p = 0.852; (k) ceftaroline: β-change −1.550, p = 0.339.

Figure 2

Evolution of drug consumption in the expanded-intensive care unit (ICU) expressed in defined daily doses (DDD)/100 bed-days. (a) Ceftriaxone: β-change 21.501, p = 0.029; (b) carbapenems: β-change 26.103, p = 0.002; (c) daptomycin: β-change 18.093, p = 0.002; (d) azithromycin: β-change 19.422, p = 0.030; (e) linezolid: β-change 9.183, p = 0.011; (f) triazoles: β-change 7.939, p = 0.089; (g) vancomycin: β-change 1.816, p = 0.079; (h) novel cephalosporins/β-lactamase inhibitors: β-change −1.698, p = 0.225; (i) echinocandins: β-change −1.525, p = 0.626; (j) liposomal amphotericin B: β-change −0.311, p = 0.852; (k) ceftaroline: β-change −1.550, p = 0.339.

Figure 3

Evolution of global antimicrobial consumption expressed in defined daily doses (DDD)/100 bed-days. (a) Hospital: β-change 124.242, p = 0.106; (b) extended-intensive care unit (ICU): β-change 97.960, p = 0.001.