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The Impact of the COVID-19 Pandemic on Antimicrobial Usage: An International Patient-Level Cohort Study
25 Pages Posted: 29 May 2024
More...Abstract
Background: This study aimed to assess changes in antimicrobial prescription during the pandemic, particularly considering their indiscriminate usage without microbiological evidence.
Methods: This is an observational, retrospective cohort study using patient-level data from Bangladesh, Brazil, India, Italy, Malawi, Nigeria, South Korea, Switzerland, and Turkey, including admission, demographic data, and clinical information from patients with pneumonia and/or acute respiratory distress syndrome (ARDS) and/or sepsis admitted in critical care units or COVID-19 specialised wards irrespective of COVID-19 positivity. Binary logistic regression models were used for antimicrobial prescriptions and linear regression for prescribed daily dose (PDD) and duration of therapy (DOT) to estimate changes between pre-pandemic and pandemic. Comparison of antimicrobial usage between COVID-19-positive, and COVID-19-negative patients was also performed. Pandemic effects on month-wise antimicrobial usage were evaluated using interrupted time series analyses.
Findings: A total of 15,277 patients were included, of which 14,058 patients (92%) were prescribed 31,701 courses of antimicrobials. The antimicrobial prescriptions significantly increased during the pandemic were: meropenem in Bangladesh (95% CI: 1·94-4·07) with increased PDD (95% CI: 1·18-1·60) and Turkey (95% CI: 1·09-1·58), moxifloxacin in Bangladesh (95% CI: 4·11-11·87), piperacillin/tazobactam in Italy (95% CI: 1·07-1·48) with increased PDD (95% CI: 1·05-1·21) and DOT (95% CI: 1·01-1·25) and azithromycin in Bangladesh (95% CI: 3·36-21·77) and Brazil (95% CI: 2·33-8·42). Azithromycin usage was significantly higher among COVID-19-positive cases. Interrupted time series analysis showed a drop in azithromycin usage at all sites after WHO guidelines v1 release with significantly decreased usage in India (95% CI: -8·38 to -3·49) and South Korea (95% CI: -2·83 to -1·89).
Interpretation: We observed increased use of AWaRe WATCH antibiotics in four countries, with heterogeneity in antimicrobial choices and volumes between countries.
Funding: This project is funded by Wellcome Trust (221579/Z/20/Z) and Ineos Oxford Institute for Antimicrobial Research.
Declaration of Interest: The authors declare no conflict of interest.
Ethical Approval: This project was approved by the Health Research Authority and Health and Care Research Wales, UK and by the appropriate ethical bodies at the collaborating sites.
Keywords: Antimicrobial consumption, Antimicrobial usage, Antimicrobial prescription, Antimicrobial stewardship
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