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Antimicrobial consumption among 66 acute care hospitals in Catalonia: impact of the COVID-19 pandemic
Grau, Santiago; Hernandez, Sergi; Echeverría-Esnal, Daniel; Almendral, Alexander; Ferrer, Ricard; Limón, Enrique; Horcajada Gallego, Juan Pablo; +1 Authors
Grau, Santiago; Hernandez, Sergi; Echeverría-Esnal, Daniel; Almendral, Alexander; Ferrer, Ricard; Limón, Enrique; Horcajada Gallego, Juan Pablo; Antimicrobial Stewardship Program;
Antimicrobial consumption among 66 acute care hospitals in Catalonia: impact of the COVID-19 pandemic
COVID-19; Consumo de antimicrobianos; Dosis diarias definidas COVID-19; Consum d'antimicrobians; Dosis diàries definides COVID-19; Antimicrobial consumption; Defined daily doses Background: Antimicrobials have been widely used during the COVID-19 pandemic. This study aimed to analyze the impact of the COVID-19 pandemic on the antimicrobial consumption of 66 hospitals in Catalonia. Methods: Adult antibacterial and antimycotic consumption was calculated as defined daily doses (DDD)/100 bed-days and DDD/100 discharges. Firstly, overall and ICU consumption in 2019 and 2020 were compared. Secondly, observed ICU 2020 consumptions were compared with non-COVID-19 2020 estimated consumptions (based on the trend from 2008–2019). Results: Overall, antibacterial consumption increased by 2.31% and 4.15% DDD/100 bed-days and DDD/100 discharges, respectively. Azithromycin (105.4% and 109.08% DDD/100 bed-days and DDD/100 discharges, respectively) and ceftriaxone (25.72% and 27.97% DDD/100 bed-days and DDD/100 discharges, respectively) mainly accounted for this finding. Likewise, antifungal consumption increased by 10.25% DDD/100 bed-days and 12.22% DDD/100 discharges, mainly due to echinocandins or amphotericin B. ICU antibacterial and antimycotic consumption decreased by 1.28% and 4.35% DDD/100 bed-days, respectively. On the contrary, antibacterial and antifungal use, expressed in DDD/100 discharges, increased by 23.42% and 19.58%. Azithromycin (275.09%), ceftriaxone (55.11%), cefepime (106.35%), vancomycin (29.81%), linezolid (31.28%), amphotericin B (87.98%), and voriconazole (96.17%) use changed the most. Observed consumption of amphotericin B, azithromycin, caspofungin, ceftriaxone, vancomycin, and voriconazole were higher than estimated values. Conclusions: The consumption indicators for most antimicrobials deviated from the expected trend pattern. A worrisome increase in antibacterial and antifungal consumption was observed in ICUs in Catalonia. The present study was carried out as part of our routine work. The VINCat program is supported by public funding from the Catalan Health Service, Department of Health, Generalitat de Catalunya.
Spain
Microsoft Academic Graph classification: Azithromycin chemistry.chemical_compound Amphotericin B Ceftriaxone Vancomycin medicine.drug medicine.medical_specialty Cefepime Internal medicine medicine Voriconazole business.industry chemistry Linezolid Caspofungin business
Medical Subject Headings: equipment and supplies
Biochemistry, antibiotics, Antibiotics, :virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES], Pharmacology (medical), :Other subheadings::/therapeutic use [Other subheadings], General Pharmacology, Toxicology and Pharmaceutics, Fungicides, :Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES], :acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos [COMPUESTOS QUÍMICOS Y DROGAS], defined daily doses, Hospitals, Infectious Diseases, antifungals, Microbiology (medical), Catalonia, Medicaments antiinfecciosos - Ús terapèutic, Antibiòtics, RM1-950, Microbiology, Article, COVID-19 (Malaltia) - Catalunya, :Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents [CHEMICALS AND DRUGS], :Otros calificadores::/uso terapéutico [Otros calificadores], COVID-19, Catalunya, Therapeutics. Pharmacology, antimicrobial consumption
Biochemistry, antibiotics, Antibiotics, :virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES], Pharmacology (medical), :Other subheadings::/therapeutic use [Other subheadings], General Pharmacology, Toxicology and Pharmaceutics, Fungicides, :Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES], :acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos [COMPUESTOS QUÍMICOS Y DROGAS], defined daily doses, Hospitals, Infectious Diseases, antifungals, Microbiology (medical), Catalonia, Medicaments antiinfecciosos - Ús terapèutic, Antibiòtics, RM1-950, Microbiology, Article, COVID-19 (Malaltia) - Catalunya, :Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents [CHEMICALS AND DRUGS], :Otros calificadores::/uso terapéutico [Otros calificadores], COVID-19, Catalunya, Therapeutics. Pharmacology, antimicrobial consumption
Microsoft Academic Graph classification: Azithromycin chemistry.chemical_compound Amphotericin B Ceftriaxone Vancomycin medicine.drug medicine.medical_specialty Cefepime Internal medicine medicine Voriconazole business.industry chemistry Linezolid Caspofungin business
Medical Subject Headings: equipment and supplies
3714
1. Dhama, K.; Khan, S.; Tiwari, R.; Sircar, S.; Bhat, S.; Malik, Y.S.; Singh, K.P.; Chaicumpa, W.; Bonilla-Aldana, D.K.; RodriguezMorales, A.J. Coronavirus disease 2019-COVID-19. Clin. Microbiol. Rev. 2020, 33, 1-48. [CrossRef] [PubMed]
2. Langford, B.J.; So, M.; Raybardhan, S.; Leung, V.; Westwood, D.; MacFadden, D.R.; Soucy, J.P.R.; Daneman, N. Bacterial coinfection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis. Clin. Microbiol. Infect. 2020, 26, 1622-1629. [CrossRef] [PubMed]
3. Grau, S.; Echeverria-Esnal, D.; Gómez-Zorrilla, S.; Navarrete-Rouco, M.E.; Masclans, J.R.; Espona, M.; Gracia-Arnillas, M.P.; Duran, X.; Comas, M.; Horcajada, J.P.; et al. Evolution of antimicrobial consumption during the first wave of covid-19 pandemic. Antibiotics 2021, 10, 132. [CrossRef]
4. WHO. COVID-19 Weekly Epidemiological Update 35; World Health Organization: Geneva, Switzerland, 2021; pp. 1-3.
5. Siddiqi, H.K.; Mehra, M.R. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J. Hear. Lung Transplant. 2020, 39, 405-407. [CrossRef] [PubMed]
6. Richardson, S.; Hirsch, J.S.; Narasimhan, M.; Crawford, J.M.; McGinn, T.; Davidson, K.W.; Barnaby, D.P.; Becker, L.B.; Chelico, J.D.; Cohen, S.L.; et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020, 10022, 1-8. [CrossRef] [PubMed]
7. Guan, W.-J.; Ni, Z.-Y.; Hu, Y.; Liang, W.-H.; Ou, C.-Q.; He, J.-X.; Liu, L.; Shan, H.; Lei, C.-L.; Hui, D.S.C.; et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N. Engl. J. Med. 2020, 382, 1708-1729. [CrossRef]
8. Russell, C.D.; Fairfield, C.J.; Drake, T.M.; Turtle, L.; Seaton, R.A.; Wootton, D.G.; Sigfrid, L.; Harrison, E.M.; Docherty, A.B.; de Silva, T.I.; 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, 5247, 1-12. [CrossRef]
9. Klein, E.Y.; Monteforte, B.; Gupta, A.; Jiang, W.; May, L.; Hsieh, Y.H.; Dugas, A. The frequency of influenza and bacterial coinfection: A systematic review and meta-analysis. Influenza Other Respi. Viruses 2016, 10, 394-403. [CrossRef] [OpenAIRE]
10. Thorburn, K.; Harigopal, S.; Reddy, V.; Taylor, N.; Van Saene, H.K.F. High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis. Thorax 2006, 61, 611-615. [CrossRef] [OpenAIRE]
citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).22 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 10% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Average impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Top 10% views 61 downloads 32 citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).22 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 10% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Average impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Top 10% - 61views32downloads
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This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
Citations provided by BIP!popularityPopularity provided by BIP!
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
Popularity provided by BIP!influenceInfluence provided by BIP!
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
Influence provided by BIP!impulseImpulse provided by BIP!
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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COVID-19; Consumo de antimicrobianos; Dosis diarias definidas COVID-19; Consum d'antimicrobians; Dosis diàries definides COVID-19; Antimicrobial consumption; Defined daily doses Background: Antimicrobials have been widely used during the COVID-19 pandemic. This study aimed to analyze the impact of the COVID-19 pandemic on the antimicrobial consumption of 66 hospitals in Catalonia. Methods: Adult antibacterial and antimycotic consumption was calculated as defined daily doses (DDD)/100 bed-days and DDD/100 discharges. Firstly, overall and ICU consumption in 2019 and 2020 were compared. Secondly, observed ICU 2020 consumptions were compared with non-COVID-19 2020 estimated consumptions (based on the trend from 2008–2019). Results: Overall, antibacterial consumption increased by 2.31% and 4.15% DDD/100 bed-days and DDD/100 discharges, respectively. Azithromycin (105.4% and 109.08% DDD/100 bed-days and DDD/100 discharges, respectively) and ceftriaxone (25.72% and 27.97% DDD/100 bed-days and DDD/100 discharges, respectively) mainly accounted for this finding. Likewise, antifungal consumption increased by 10.25% DDD/100 bed-days and 12.22% DDD/100 discharges, mainly due to echinocandins or amphotericin B. ICU antibacterial and antimycotic consumption decreased by 1.28% and 4.35% DDD/100 bed-days, respectively. On the contrary, antibacterial and antifungal use, expressed in DDD/100 discharges, increased by 23.42% and 19.58%. Azithromycin (275.09%), ceftriaxone (55.11%), cefepime (106.35%), vancomycin (29.81%), linezolid (31.28%), amphotericin B (87.98%), and voriconazole (96.17%) use changed the most. Observed consumption of amphotericin B, azithromycin, caspofungin, ceftriaxone, vancomycin, and voriconazole were higher than estimated values. Conclusions: The consumption indicators for most antimicrobials deviated from the expected trend pattern. A worrisome increase in antibacterial and antifungal consumption was observed in ICUs in Catalonia. The present study was carried out as part of our routine work. The VINCat program is supported by public funding from the Catalan Health Service, Department of Health, Generalitat de Catalunya.
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