Antibiotics

Research

11 pages, 2297 KiB

Open AccessArticle

National Level Cross-Sectional Study on Antibiotic Use in Children during the Pre- and Early COVID-19 Eras

by Ji Young Park and Hyun Mi Kang

Antibiotics 2024, 13(3), 249; https://doi.org/10.3390/antibiotics13030249 - 9 Mar 2024

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This study aimed to investigate national data for a quantitative evaluation of antibiotic usage in Korean children during the pre- and early COVID-19 period. This was a cross-sectional study from 2016 to 2021 of children <18 years, grouped by age (0, 1, 2–4, [...] Read more.

This study aimed to investigate national data for a quantitative evaluation of antibiotic usage in Korean children during the pre- and early COVID-19 period. This was a cross-sectional study from 2016 to 2021 of children <18 years, grouped by age (0, 1, 2–4, 5–11, and 12–17 years) and city/province. Systemic antibiotic prescriptions, days of administration, and population by age and region were collected. Days of therapy (DOT)/1000 pediatric inhabitant per day (PID) was used for antibiotic quantitative monitoring. A total of 257,088,265 antibiotic doses were prescribed to 170,309,944 children during the 6-year period. The highest DOT during the entire study period was observed in the 1-year age group, followed by the 2–4- and 0-year age groups. The highest DOT was observed in 2019, with 72.8 DOT/1000 PID in the 1-year age group, which fell to 34.7 DOT/1000 PID in 2020, however, DOT soon increased at similar rates to that in the pre-COVID-19 period. A higher DOT/1000 PID was observed for third-generation cephalosporins in 58.8% of the regions compared to beta-lactam/beta-lactamase inhibitors. To conclude, reductions in antibiotic use during the early COVID-19 pandemic period were not maintained. Further interventions are needed to decrease antibiotic overuse and misuse. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing Practices and Antimicrobial Resistance in the COVID-19 Pandemic)

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12 pages, 2662 KiB

Open AccessArticle

The Impact of COVID-19 on Multidrug-Resistant Bacteria at a Slovenian Tertiary Medical Center

by Tatjana Mrvič, Sintija Stevanoska, Bojana Beović, Mateja Logar, Sergeja Gregorčič, Benica Žnidaršič, Katja Seme, Ivana Velimirović, Nataša Švent Kučina, Polona Maver Vodičar, Veronika Križan Hergouth, Sašo Džeroski and Mateja Pirs

Antibiotics 2024, 13(3), 214; https://doi.org/10.3390/antibiotics13030214 - 23 Feb 2024

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Abstract

The COVID-19 pandemic has strained healthcare systems globally. Shortages of hospital beds, reassignment of healthcare workers to COVID-19-dedicated wards, an increased workload, and evolving infection prevention and control measures have potentially contributed to the spread of multidrug-resistant bacteria (MDRB). To determine the impact [...] Read more.

The COVID-19 pandemic has strained healthcare systems globally. Shortages of hospital beds, reassignment of healthcare workers to COVID-19-dedicated wards, an increased workload, and evolving infection prevention and control measures have potentially contributed to the spread of multidrug-resistant bacteria (MDRB). To determine the impact of the COVID-19 pandemic at the University Medical Center Ljubljana, a tertiary teaching hospital, we analyzed the monthly incidence of select bacterial species per patient from 2018 to 2022. The analysis was performed for all isolates and for MDRB isolates. The data were analyzed separately for isolates from all clinical samples, from blood culture only, and from clinical and surveillance samples. Our findings revealed an increased incidence density of patients with Enterococcus faecium, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa isolates from clinical samples during the COVID-19 period in the studied hospital. Notably, the incidence density of MDRB isolates—vancomycin-resistant E. faecium, extended-spectrum betalactamase-producing K. pneumoniae, and betalactam-resistant P. aeruginosa—from clinical samples increased during the COVID-19 period. There were no statistically significant differences in the incidence density of patients with blood culture MDRB isolates. We observed an increase in the overall MDRB burden (patients with MDRB isolates from both clinical and surveillance samples per 1000 patient days) in the COVID-19 period in the studied hospital for vancomycin-resistant E. faecium, carbapenem-resistant K. pneumoniae, and betalactam-resistant P. aeruginosa and a decrease in the methicillin-resistant S. aureus burden. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing Practices and Antimicrobial Resistance in the COVID-19 Pandemic)

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12 pages, 2102 KiB

Open AccessArticle

An Ocean between the Waves: Trends in Antimicrobial Consumption in Hospitalized Patients with COVID-19

by Xavier Durà-Miralles, Gabriela Abelenda-Alonso, Alba Bergas, Júlia Laporte-Amargós, Enric Sastre-Escolà, Ariadna Padullés, Jordi Carratalà and Carlota Gudiol

Antibiotics 2024, 13(1), 55; https://doi.org/10.3390/antibiotics13010055 - 5 Jan 2024

Cited by 1 | Viewed by 1209

Abstract

We assessed the antibiotic use in SARS-CoV-2-infected patients during four different waves of the COVID-19 pandemic, as well as its trends over the period and associated risk factors. We performed a cross-sectional retrospective analysis nested in a prospectively collected cohort of hospitalized adult [...] Read more.

We assessed the antibiotic use in SARS-CoV-2-infected patients during four different waves of the COVID-19 pandemic, as well as its trends over the period and associated risk factors. We performed a cross-sectional retrospective analysis nested in a prospectively collected cohort of hospitalized adult patients with COVID-19 at a university hospital in Spain. A total of 2415 patients were included in this study, among whom 1120 corresponded to the first wave. The highest percentage of patients receiving some sort of antibiotic treatment was higher during the first wave (77.6%) than during the others; nevertheless, our calculation of the average DOT (days of antibiotic treatment) per 100 patient days of stay found that the highest antibiotic prescription rate corresponded to the second pandemic wave (61.61 DOT/100 patient days), which was associated with a higher ICU admission rate and a lower SpO₂/FiO₂ ratio at admission. After the second wave, the prescription rates presented a steady downward trend. With regard to the use of specific antibiotic families, amoxicillin/clavulanate was the most used antibiotic in our cohort (14.20 DOT/100 patient days) due to a high prescription rate during the first wave. According to the “AWaRe” WHO classification, antibiotics corresponding to the “Watch” group were the most prescribed (27.92 DOT/100 patient days). The antibiotic use rate fell progressively, but it remained high during all four waves analyzed. In conclusion, antibiotic use was high throughout all the waves that were analyzed, despite a relatively low incidence of bacterial coinfection and superinfection. Efforts should be made to keep antimicrobial stewardship programs active, especially in complicated epidemiological situations, such as the SARS-CoV-2 pandemic. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing Practices and Antimicrobial Resistance in the COVID-19 Pandemic)

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10 pages, 267 KiB

Open AccessArticle

Public Knowledge, Attitudes, and Practices towards Antibiotic Use and Antimicrobial Resistance in Eastern Region of Bosnia and Herzegovina in the COVID-19 Pandemic

by Dragana Drakul, Bojan Joksimović, Marija Milić, Milica Radanović, Nikolina Dukić, Nenad Lalović, Desmond Nischolson, Biljana Mijović and Dragana Sokolović

Antibiotics 2023, 12(8), 1274; https://doi.org/10.3390/antibiotics12081274 - 2 Aug 2023

Cited by 1 | Viewed by 1115

Abstract

The constant worsening of antimicrobial resistance (AMR) imposes the need for an urgent response. Use of antibiotics (AB), both due to irrational prescribing by doctors and irrational use by patients, is recognized as one of the leading causes of this problem. This study [...] Read more.

The constant worsening of antimicrobial resistance (AMR) imposes the need for an urgent response. Use of antibiotics (AB), both due to irrational prescribing by doctors and irrational use by patients, is recognized as one of the leading causes of this problem. This study aimed to identify knowledge, attitudes, and practices about AB use and AMR within the general population, stratified by age, gender, and urban/rural areas during the COVID-19 pandemic. This questionnaire-based cross-sectional study was conducted in April 2022 among patients who visited three health centers in the eastern region of Bosnia and Herzegovina. A high frequency of AB use was observed during the COVID-19 pandemic (64.2% of respondents were treated with AB). Age and place of residence have not been shown to be factors associated with AB use practices that pose a risk for AMR. However, female gender (β = 0.063; p = 0.041), better knowledge (β = 0.226; p < 0.001), and positive attitudes (β = 0.170; p < 0.001) about use of AB and towards to AMR proved to be factors associated with better practice by respondents. Women, younger respondents, and respondents from urban areas showed better knowledge, attitudes, and behavior about the use of AB and AMR during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing Practices and Antimicrobial Resistance in the COVID-19 Pandemic)

11 pages, 685 KiB

Open AccessArticle

Effect of the COVID-19 Pandemic on Rates and Epidemiology of Clostridioides difficile Infection in One VA Hospital

by Lorinda M. Wright, Andrew M. Skinner, Adam Cheknis, Conor McBurney, Ling Ge, Susan M. Pacheco, David Leehey, Dale N. Gerding and Stuart Johnson

Antibiotics 2023, 12(7), 1159; https://doi.org/10.3390/antibiotics12071159 - 7 Jul 2023

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Abstract

The COVID-19 pandemic was associated with increases in some healthcare-associated infections. We investigated the impact of the pandemic on the rates and molecular epidemiology of Clostridioides difficile infection (CDI) within one VA hospital. We anticipated that the potential widespread use of antibiotics for [...] Read more.

The COVID-19 pandemic was associated with increases in some healthcare-associated infections. We investigated the impact of the pandemic on the rates and molecular epidemiology of Clostridioides difficile infection (CDI) within one VA hospital. We anticipated that the potential widespread use of antibiotics for pneumonia during the pandemic might increase CDI rates given that antibiotics are a major risk for CDI. Hospital data on patients with CDI and recurrent CDI (rCDI) were reviewed both prior to the COVID-19 pandemic (2015 to 2019) and during the pandemic (2020–2021). Restriction endonuclease analysis (REA) strain typing was performed on CD isolates recovered from stool samples collected from October 2019 to March 2022. CDI case numbers declined by 43.2% in 2020 to 2021 compared to the annual mean over the previous 5 years. The stool test positivity rate was also lower during the COVID-19 pandemic (14.3% vs. 17.2%; p = 0.013). Inpatient hospitalization rates declined, and rates of CDI among inpatients were reduced by 34.2% from 2020 to 2021. The mean monthly cases of rCDI also declined significantly after 2020 [3.38 (95% CI: 2.89–3.87) vs. 1.92 (95% CI: 1.27–2.56); p = <0.01]. Prior to the pandemic, REA group Y was the most prevalent CD strain among the major REA groups (27.3%). During the first wave of the pandemic, from 8 March 2020, to 30 June 2020, there was an increase in the relative incidence of REA group BI (26.7% vs. 9.1%); After adjusting for CDI risk factors, a multivariable logistic regression model revealed that the odds of developing an REA group BI CDI increased during the first pandemic wave (OR 6.41, 95% CI: 1.03–39.91) compared to the pre-pandemic period. In conclusion, the incidence of CDI and rCDI decreased significantly during the COVID-19 pandemic. In contrast, REA BI (Ribotype 027), a virulent, previously epidemic CD strain frequently associated with hospital transmission and outbreaks, reappeared as a prevalent strain during the first wave of the pandemic, but subsequently disappeared, and overall CDI rates declined. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing Practices and Antimicrobial Resistance in the COVID-19 Pandemic)

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10 pages, 795 KiB

Open AccessFeature PaperArticle

Risk Factors Associated with the Development of Hospital-Acquired Infections in Hospitalized Patients with Severe COVID-19

by Fernando Solís-Huerta, Bernardo Alfonso Martinez-Guerra, Carla Marina Roman-Montes, Karla Maria Tamez-Torres, Sandra Rajme-Lopez, Narciso Ortíz-Conchi, Norma Irene López-García, Guadalupe Yvonne Villalobos-Zapata, Andrea Rangel-Cordero, Janet Santiago-Cruz, Luis Fernando Xancal-Salvador, Steven Méndez-Ramos, Eric Ochoa-Hein, Arturo Galindo-Fraga, Alfredo Ponce-de-Leon, Maria Fernanda Gonzalez-Lara and Jose Sifuentes-Osornio

Antibiotics 2023, 12(7), 1108; https://doi.org/10.3390/antibiotics12071108 - 27 Jun 2023

Cited by 1 | Viewed by 1035

Abstract

Recognition of risk factors for hospital-acquired infections (HAI) in patients with COVID-19 is warranted. We aimed to describe factors associated with the development of HAI in patients with severe COVID-19. We conducted a retrospective cohort study including all adult patients admitted with severe [...] Read more.

Recognition of risk factors for hospital-acquired infections (HAI) in patients with COVID-19 is warranted. We aimed to describe factors associated with the development of HAI in patients with severe COVID-19. We conducted a retrospective cohort study including all adult patients admitted with severe COVID-19 between March 2020 and November 2020. The primary outcome was HAI development. Bivariate and multiple logistic regression models were constructed. Among 1540 patients, HAI occurred in 221 (14%). A total of 299 episodes of HAI were registered. The most common HAI were hospital-acquired/ventilation-associated pneumonia (173 episodes) and primary bloodstream infection (66 episodes). Death occurred in 387 (35%) patients and was more frequent in patients with HAI (38% vs. 23%, p < 0.01). Early mechanical ventilation (aOR 18.78, 95% CI 12.56–28.07), chronic kidney disease (aOR 3.41, 95% CI 1.4–8.27), use of corticosteroids (aOR 2.95, 95% CI 1.92–4.53) and tocilizumab (aOR 2.68, 95% CI 1.38–5.22), age ≥ 60 years (aOR 1.91, 95% CI 1.27–2.88), male sex (aOR 1.52, 95% CI 1.03–2.24), and obesity (aOR 1.49, 95% CI 1.03–2.15) were associated with HAI. In patients with severe COVID-19, mechanical ventilation within the first 24 h upon admission, chronic kidney disease, use of corticosteroids, use of tocilizumab, age ≥ 60 years, male sex, and obesity were associated with a higher risk of HAI. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing Practices and Antimicrobial Resistance in the COVID-19 Pandemic)

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11 pages, 1439 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Community Consumption of Antibiotics for Systemic Use and Resistance of Invasive Streptococcus pneumoniae in Slovenia

by Tamara Kastrin, Verica Mioč, Aleksander Mahnič, Milan Čižman and Slovenian Meningitidis Study Group

Antibiotics 2023, 12(6), 945; https://doi.org/10.3390/antibiotics12060945 - 23 May 2023

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Abstract

The present study aims to investigate the impact of the COVID-19 pandemic on community antibiotic consumption and the resistance of invasive Streptococcus pneumoniae (2015–2022) to penicillin in Slovenia. During the pandemic in 2020 and 2021, the total use of antibiotics for systemic use [...] Read more.

The present study aims to investigate the impact of the COVID-19 pandemic on community antibiotic consumption and the resistance of invasive Streptococcus pneumoniae (2015–2022) to penicillin in Slovenia. During the pandemic in 2020 and 2021, the total use of antibiotics for systemic use decreased by 23.5% and 24.3%, expressed in defined daily doses per 1000 inhabitants per day (DID), while the use of penicillins, macrolides and broad-spectrum penicillins decreased by 30%, 20% and by 17.5%, respectively, and that of broad-spectrum macrolides fell by 17.1%. The incidence of invasive pneumococcal diseases (IPD) in Slovenia had a large decline during the pandemic. Decreased resistance to macrolides was significantly associated with decreased use of macrolides, while for penicillins the correlation could not be statistically confirmed. The proportion of PCV13 serotypes in IPD in Slovenia decreased after the introduction of the vaccine in the national programme, falling from 81.6% in 2015 to 45.5% in 2022. We noticed a decrease in the serotypes 1, 14, 9V, 7F, 4, 6A and an increase in the serotypes 3, 8, 22F, 11A, 23A and 15A. National interventions during the COVID-19 pandemic substantially decreased outpatients’ antibiotic consumption, as well as incidence and resistance of invasive S. pneumoniae. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing Practices and Antimicrobial Resistance in the COVID-19 Pandemic)

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8 pages, 567 KiB

Open AccessArticle

Changes in Medication Prescribing Due to COVID-19 in Dental Practice in Croatia—National Study

by Ivana Šutej, Dragan Lepur, Krešimir Bašić, Luka Šimunović and Kristina Peroš

Antibiotics 2023, 12(1), 111; https://doi.org/10.3390/antibiotics12010111 - 7 Jan 2023

Cited by 1 | Viewed by 1733

Abstract

The 2019 coronavirus pandemic (COVID-19) has affected clinical practice and, consequently, drug prescribing in dental practice. We investigated how the pandemic affected the prescribing behavior of dentists in Croatia. Data on prescribing practices for this study were provided by the Croatian Health Insurance [...] Read more.

The 2019 coronavirus pandemic (COVID-19) has affected clinical practice and, consequently, drug prescribing in dental practice. We investigated how the pandemic affected the prescribing behavior of dentists in Croatia. Data on prescribing practices for this study were provided by the Croatian Health Insurance Institute. The analysis included the number of prescriptions, costs, and the number of packages prescribed. The World Health Organization’s defined daily dose per 1000 inhabitants (DID) per day was used as an objective utilization comparison. During the first pandemic year, prescribing practice changed the most. Wide-spectrum antibiotics, analgesics, and antiseptics showed the highest trend in change. A statistically significant change in prescribing practices during the pandemic period was noted for amoxicillin with clavulanic acid, ibuprofen, and ketoprofen which showed an increase in trend, while cephalexin and diclofenac showed a statistically significant decrease. The highest increase in trend was recorded for azithromycin, at +39.3%. The COVID-19 pandemic has been associated with a marked increase in medication utilization, especially in the first year of the pandemic. The increase in wide-spectrum antibiotic classes needs to be addressed and regulated so that patients accept that antibiotics are not a substitute for dental treatment and dentists always start treatment with narrow-spectrum antibiotics regardless of specific times, as is the case with the pandemic. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing Practices and Antimicrobial Resistance in the COVID-19 Pandemic)

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