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. 2023 Jun 4;12(6):1009.
doi: 10.3390/antibiotics12061009.

Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times

Marcella Sibani  1 , Lorenzo Maria Canziani  2 , Chiara Tonolli  3 , Maddalena Armellini  2 , Elena Carrara  2 , Fulvia Mazzaferri  1 , Michela Conti  2 , Save Working Group, Annarita Mazzariol  4 , Claudio Micheletto  5 , Andrea Dalbeni  6 , Domenico Girelli  7 , Evelina Tacconelli  2
Affiliations

Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times

Marcella Sibani et al. Antibiotics (Basel). .

Abstract

Background: Since the SARS-CoV-2 pandemic emerged, antimicrobial stewardship (AS) activities need to be diverted into COVID-19 management.

Methods: In order to assess the impact of COVID-19 on AS activities, we analyzed changes in antibiotic consumption in moderate-to-severe COVID-19 patients admitted to four units in a tertiary-care hospital across three COVID-19 waves. The AS program was introduced at the hospital in 2018. During the first wave, COVID-19 forced the complete withdrawal of hospital AS activities. In the second wave, antibiotic guidance calibration for COVID-19 patients was implemented in all units, with enhanced stewardship activities in Units 1, 2, and 3 (intervention units). In a controlled before and after study, antimicrobial usage during the three waves of the COVID-19 pandemic was compared to the 12-month prepandemic unit (Unit 4 acted as the control). Antibiotic consumption data were analyzed as the overall consumption, stratified by the World Health Organization AWaRe classification, and expressed as defined-daily-dose (DDD) and days-of-therapy (DOT) per 1000 patient-day (PD).

Results: In the first wave, the overall normalized DOT in units 2-4 significantly exceeded the 2019 level (2019: 587 DOT/1000 PD ± 42.6; Unit 2: 836 ± 77.1; Unit 3: 684 ± 122.3; Unit 4: 872, ± 162.6; p < 0.05). After the introduction of AS activities, consumption decreased in the intervention units to a significantly lower level when compared to 2019 (Unit 1: 498 DOT/1000 PD ± 49; Unit 2: 232 ± 95.7; Unit 3: 382 ± 96.9; p < 0.05). Antimicrobial stewardship activities resulted in a decreased amount of total antibiotic consumption over time and positively affected the watch class and piperacillin-tazobactam use in the involved units.

Conclusions: During a pandemic, the implementation of calibrated AS activities represents a sound investment in avoiding inappropriate antibiotic therapy.

Keywords: COVID-19; antibiotic consumption; antimicrobial stewardship.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of the overall ATC-J01 antimicrobial consumption in the prepandemic period and during the COVID-19 pandemic: (a) Consumption trend (DOT/1000 PD) in the hospital’s medical area targeted by the hospital’s AS program in the period 2017–2019 [24]; (b) consumption trends (DOT/1000 PD) in the 4 COVID-19 dedicated wards; monthly consumption data in the COVID-19 period are provided in the table.
Figure 2
Figure 2
Normalized DOT/1000 PD of AWaRe antibiotics; overall consumption is reported as the percentage of access, watch, and reserve by COVID-19 waves.
Figure 3
Figure 3
AS intervention timeline and patient days (PD) per unit per wave. *WHO SI = World Health Organization Ordinal Scale for clinical improvement in COVID-19 patients: 1: ambulatory patients, no limitation of activities; 2: ambulatory patients, with limitation of activities; 3: hospitalized patients, no oxygen therapy needed; 4: hospitalized patients, oxygen by mask or nasal cannulae needed; 5: hospitalized, severe disease, noninvasive ventilation, or high flow oxygen needed.
See this image and copyright information in PMC

References

    1. Calderon M., Gysin G., Gujjar A., McMaster A., King L., Comandé D., Hunter E., Payne B. Bacterial co-infection and antibiotic stewardship in patients with COVID-19: A systematic review and meta-analysis. BMC Infect. Dis. 2023;23:14. doi: 10.1186/s12879-022-07942-x. - DOI - PMC - PubMed
    1. Langford B.J., Soucy J.-P.R., Leung V., So M., Kwan A.T., Portnoff J.S., Bertagnolio S., Raybardhan S., MacFadden D.R., Daneman N. Antibiotic resistance associated with the COVID-19 pandemic: A systematic review and meta-analysis. Clin. Microbiol. Infect. 2023;29:302–309. doi: 10.1016/j.cmi.2022.12.006. - DOI - PMC - PubMed
    1. Grau S., Hernández S., Echeverría-Esnal D., Almendral A., Ferrer R., Limón E., Horcajada J.P., Catalan Infection Control and Antimicrobial Stewardship Program (VINCat-PROA) Antimicrobial Consumption among 66 Acute Care Hospitals in Catalonia: Impact of the COVID-19 Pandemic. Antibiotics. 2021;10:943. doi: 10.3390/antibiotics10080943. - DOI - PMC - PubMed
    1. Murgadella-Sancho A., Coloma-Conde A., Oriol-Bermúdez I. Impact of the strategies implemented by an antimicrobial stewardship program on the antibiotic consumption in the coronavirus disease 2019 (COVID-19) pandemic. Infect. Control. Hosp. Epidemiol. 2022;43:1292–1293. doi: 10.1017/ice.2021.237. - DOI - PMC - PubMed
    1. Vaughn V.M., Gandhi T.N., Petty L.A., Patel P.K., Prescott H.C., Malani A.N., Ratz D., McLaughlin E., Chopra V., Flanders S.A. Empiric Antibacterial Therapy and Community-onset Bacterial Coinfection in Patients Hospitalized With Coronavirus Disease 2019 (COVID-19): A Multi-hospital Cohort Study. Clin. Infect. Dis. 2021;72:e533–e541. doi: 10.1093/cid/ciaa1239. - DOI - PMC - PubMed