Antimicrobial use assessment in the Intensive Care Unit of a public and reference hospital for COVID-19 in the Federal District
DOI:
https://doi.org/10.30968/rbfhss.2023.144.0968Abstract
Objective: To compare Intensive Care Unit antimicrobial consumption in previous periods and during the COVID-19 pandemic, to determine the prevalence of bacterial and fungal microorganisms, the prevalence of coinfection and secondary infections, and describe the profile of antimicrobial resistance throughout the pandemic. Method: retrospective observational study, from March to December 2020 in a public COVID reference hospital in the Federal District, including adult patients admitted to the ICU and using antimicrobials. Antimicrobial consumption, expressed in DDD/1000 patient-days and according to the AwaRe categorization, were compared before and during the COVID-19 pandemic. Secondary data were obtained through microbiology laboratory reports. The profile of the population was also characterized. For statistical analysis, the Mann-Whitney U test was used to compare the variables in the studied periods. Results: in the study were included 137 patients. There was a significant reduction in antimicrobial consumption in the access group Ampicillin/Sulbactam (P=0.035) during the pandemic. In the Watch group, consumption was significantly higher during the pandemic period for the antimicrobials Ceftriaxone and Piperacilian/Tazobactan (P<0.001; P= 0.015, respectively). In the Reserve group, there was a reduction in Polymyxin B during the pandemic period (P=0.029). There was also a significant reduction (P=0.009) of Echinocandins (Anidulafungin/Micafungin). Only 5.43% of patients had coinfection. Of the 731 cultures collected, 67.48% were positive for gram-negative bacteria, 19.51% for gram-positive bacteria and 13.01% for fungi. Among the microorganisms at greatest risk of antimicrobial resistance, the carbapenem-resistant Klebsiella pneumoniae species was identified in 100% of blood cultures and urine cultures and in 92% of tracheal secretion cultures; Acinetobacter spp species resistant to carbapenems occurred in 90% of blood cultures and in 98% of tracheal secretion cultures. Conclusion: the results showed a trend towards increased consumption of broad-spectrum antimicrobials in the Watch group, but with a reduction in consumption for the Reserve group. The high use of antimicrobials prior to ICU admission, associated with a reduced rate of co-infection, suggests the wide empirical use of antimicrobials in patients without proven bacterial infection. This is of concern in the context of the treatment of multidrug-resistant infections.
Downloads
References
World Health Organization, Novel Coronavirus (2019-nCoV) Situation report-1, 21 January 2020. Geneva, Switzerland. Disponível em: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4; acessado em 23 janeiro 2023
Al Mutair, A., Al Mutairi, A., Alhumaid, S., Maaz Abdullah, S., Zia Zaidi, A. R., Rabaan, A. A., & Al-Omari, A. (2021). Examining and investigating the impact of demographic characteristics and chronic diseases on mortality of COVID-19: Retrospective study. PloS one, 16(9), e0257131. https://doi.org/10.1371/ journal.pone.0257131.
Nuño, M., García, Y., Rajasekar, G., Pinheiro, D., & Schmidt, A. J. (2021). COVID-19 hospitalizations in five California hospitals: a retrospective cohort study. BMC infectious diseases, 21(1), 938. https://doi.org/10.1186/s12879-021-06640-4.
Banoei, M. M., Dinparastisaleh, R., Zadeh, A. V., & Mirsaei- di, M. (2021). Machine-learning-based COVID-19 mortality prediction model and identification of patients at low and high risk of dying. Critical care (London, England), 25(1), 328. https://doi.org/10.1186/s13054-021-03749-5.
Rosenthal N, Cao Z, Gundrum J, Sianis J, Safo S. Risk Factors Associated With In-Hospital Mortality in a US National Sample of Patients With COVID-19. JAMA Network Open. 2020;3(12):e2029058-e2029058. doi:10.1001/jamanetworkopen.2020.29058.
De Giorgi A, Fabbian F, Greco S, et al. Prediction of in-hospital mortality of patients with SARS-CoV-2 infection by comorbi- dity indexes: an Italian internal medicine single center study. Eur Rev Med Pharmacol Sci. Oct 2020;24(19):10258-10266. doi: https://doi.org/10.26355/eurrev_202010_23250.
Dominguez-Ramirez L, Rodriguez-Perez F, Sosa-Jurado F, Santos-Lopez G, Cortes-Hernandez P. The role of meta- bolic comorbidity in COVID-19 mortality of middle-aged adults. The case of Mexico. 2020:2020.12.15.20244160. doi:10.1101/2020.12.15.20244160 %J medRxiv.
Chung, D. R., and Huh, K. Novel Pandemic Influenza A (H1N1) and Community-Associated Methicillin-Resistant Staphylo- coccus aureus Pneumonia. Expert Rev. Anti Infect. Ther. 2015.13, 197–207. doi:10.1586/14787210.2015.999668.
Centers for Disease Control and Prevention. COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta, GA: U.S. Department of Health and Human Servi- ces, CDC; 2022. Disponível em: https://www.cdc.gov/drugresistance/covid19.html; acessado em Dezembro 2022. doi: https://doi.org/10.15620/cdc:117915.
Rodríguez-Baño, J., Rossolini, G. M., Schultsz, C., Tacconelli, E., Murthy, S., Ohmagari, N., Holmes, A., Bachmann, T., Goos- sens, H., Canton, R., Roberts, A. P., Henriques-Normark, B., Clancy, C. J., Huttner, B., Fagerstedt, P., Lahiri, S., Kaushic, C., Hoffman, S. J., Warren, M., Zoubiane, G., … Plant, L. (2021). Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillan- ce. Transactions of the Royal Society of Tropical Medicine and Hygiene, 115(10), 1122–1129. https://doi.org/10.1093/ trstmh/trab048.
Hsu J. (2020). How covid-19 is accelerating the threat of anti- microbial resistance. BMJ (Clinical research ed.), 369, m1983. https://doi.org/10.1136/bmj.m1983.
B.D. Huttner, G. Catho, J.R. Pano-Pardo, C. Pulcini, J. Schou- ten, COVID-19: don’t neglect antimicrobial stewardship principles!, Volume 26, Issue 7,2020,Pages 808-810, ISSN 1198-743X.doi: https://doi.org/10.1016/j.cmi.2020.04.024.
Clancy, C. J., & Nguyen, M. H. (2020). Coronavirus Disease 2019, Superinfections, and Antimicrobial Development: What Can We Expect?. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 71(10), 2736–2743. https://doi.org/10.1093/cid/ciaa524.
Lehmann CJ, Pho MT, Pitrak D, Ridgway JP, Pettit NN. Commu- nity acquired co-infection in COVID-19: a retrospective observational experience. [published online ahead of print July 1, 2020]. Clin Infect Dis. 2020:ciaa902. https://doi.org/10.1093/cid/ciaa902
Lansbury, L., Lim, B., Baskaran, V., & Lim, W. S. (2020). Co-infections in people with COVID-19: a systematic review and meta-analysis. The Journal of infection, 81(2), 266–275. https://doi.org/10.1016/j.jinf.2020.05.046.
O’Neill, J. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. Review on Antimicrobial Re- sistance. Wellcome Trust and HM Government. 2016. Dispo- nível em: https://amr-review.org/sites/default/files/160525_ Final%20paper_with%20cover.pdf . Acessado em: Dezembro 2022.
Rawson, T. M., Moore, L. S. P., Zhu, N., Ranganathan, N., Sko- limowska, K., Gilchrist, M., Satta, G., Cooke, G., & Holmes, A. (2020). Bacterial and Fungal Coinfection in Individuals with Coronavirus: A Rapid Review To Support COVID-19 Antimicro- bial Prescribing. Clinical infectious diseases: an official publi- cation of the Infectious Diseases Society of America, 71(9), 2459–2468. https://doi.org/10.1093/cid/ciaa530
da Silva, R. M. R., de Mendonça, S. C. B., Leão, I. N., Dos Santos, Q. N., Batista, A. M., Melo, M. S., Xavier, M. D. M., Quintans Júnior, L. J., da Silva, W. B., & Lobo, I. M. F. (2021). Use of monitoring indicators in hospital management of antimicrobials. BMC infectious diseases, 21(1), 827. https://doi.org/10.1186/s12879-021-06542-5.
Guisado-Gil, A. B., Infante-Domínguez, C., Peñalva, G., Praena, J., Roca, C., Navarro-Amuedo, M. D., Aguilar-Guisado, M., Es- pinosa-Aguilera, N., Poyato-Borrego, M., Romero-Rodríguez, N., Aldabó, T., Salto-Alejandre, S., Ruiz-Pérez de Pipaón, M., Lepe, J. A., Martín-Gutiérrez, G., Gil-Navarro, M. V., Molina, J., Pachón, J., Cisneros, J. M., & On Behalf Of The Prioam Team (2020). Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Mul- tidrug-Resistant Bloodstream Infections. Antibiotics (Basel, Switzerland), 9(11), 816. https://doi.org/10.3390/antibioti- cs9110816.
Rawson, T. M., Ming, D., Ahmad, R., Moore, L. S. P., & Holmes, A. H. (2020). Antimicrobial use, drug-resistant infections and COVID-19. Nature reviews. Microbiology, 18(8), 409–410. https://doi.org/10.1038/s41579-020-0395-y.
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) (2021). Antimicrobial Consumption among 66 Acute Care Hospitals in Catalonia: Impact of the COVID-19 Pande- mic. Antibiotics (Basel, Switzerland), 10(8), 943. https://doi.org/10.3390/antibiotics10080943.
BRASIL. Ministério da Saúde. Saiba como é feita a definição de casos suspeitos de Covid-19 no Brasil. [Brasília]: Ministério da Saúde, 12/05/2021. Disponível em: https://www.gov.br/saude/pt-br/coronavirus/artigos/definicao-e-casos-suspei- tos. Acesso em: 20 dezembro 2022
Barlam, T., Al Mohajer, M., Al-Tawfiq, J., Auguste, A., Cunha, C., Forrest, G., Schaffzin, J. (2022). SHEA statement on antibiotic stewardship in hospitals during public health emergencies. Infection Control & Hospital Epidemiology, 43(11), 1541-1552. doi:10.1017/ice.2022.194.
Brasil. Agência Nacional de Vigilância Sanitária. Prevenção de infecções por microrganismos multirresistentes em serviços de saúde – Série Segurança do Paciente e Qualidade em Serviços de Saúde/Agência Nacional de Vigilância Sanitária – Brasília: ANVISA, 2021.
WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2023. Oslo, Norway, 2022
WHO Access, Watch, Reserve (AWaRE) classification of antibiotics for evaluation and monitoring of use, 2021. Geneva: World Health Organization; 2021 (WHO/MHP/HPS/ EML/2021.04).
World Health Organization. Global antimicrobial resis- tance and use surveillance system (GLASS) report: 2022. World Health Organization. https://apps.who.int/iris/ handle/10665/364996.
WHO COVID-19 Dashboard. Geneva: World Health Organiza- tion, 2020. Disponível em: https://covid19.who.int/. Acesso em: 01 fevereiro 2023.
de Oliveira, A. Z., de Oliveira, M. L. C., Cardoso, F. R. G., & Siqueira, S. S. (2021). Profile of patients presenting hospi- tal-acquired infection at intensive care units of public hospitals. Revista De Epidemiologia E Controle De Infecção, 10(4). https://doi.org/10.17058/reci.v10i4.13103.
Stall, N. M., Wu, W., Lapointe-Shaw, L., Fisman, D. N., Gian- nakeas, V., Hillmer, M. P., & Rochon, P. A. (2020). Sex- and Age-Specific Differences in COVID-19 Testing, Cases, and Outco- mes: A Population-Wide Study in Ontario, Canada. Journal of the American Geriatrics Society, 68(10), 2188–2191. https://doi.org/10.1111/jgs.16761
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. (2021). Empiric Antibacterial Therapy and Community-onset Bacterial Coinfection in Patients Hospitalized With Coronavirus Disease 2019 (COVID-19): A Multi-hospital Cohort Study. Clinical infectious diseases, 72(10), e533–e541. https://doi.org/10.1093/cid/ciaa1239.
Langford, B. J., So, M., Raybardhan, S., Leung, V., Westwood, D., MacFadden, D. R., Soucy, J. R., & Daneman, N. (2020). Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Cli- nical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 26(12), 1622–1629. https://doi.org/10.1016/j. cmi.2020.07.016
He, Y., Li, W., Wang, Z., Chen, H., Tian, L., & Liu, D. (2020). Nosocomial infection among patients with COVID-19: A retrospective data analysis of 918 cases from a single center in Wuhan, China. Infection control and hospital epidemiology, 41(8), 982–983. https://doi.org/10.1017/ice.2020.126
O’Kelly, B., Cronin, C., Connellan, D., Griffin, S., Connolly, S. P., McGrath, J., Cotter, A. G., McGinty, T., Muldoon, E. G., Sheehan, G., Cullen, W., Doran, P., McHugh, T., Vidal, L., Avramovic, G., & Lambert, J. S. (2021). Antibiotic prescribing pat- terns in patients hospitalized with COVID-19: lessons from the first wave. JAC-antimicrobial resistance, 3(2), dlab085. https://doi.org/10.1093/jacamr/dlab085.
CDC. COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022. Disponível em: https://www.cdc.gov/drugresistance/covid19.html. DOI: https:/doi.org/10.15620/cdc:117915.
Da Silva, R. M. R., de Mendonça, S. C. B., Leão, I. N., Dos Santos, Q. N., Batista, A. M., Melo, M. S., et al. (2021). Use of Monitoring Indicators in Hospital Management of Antimicrobials. BMC Infect. Dis. 21, 827. doi:10.1186/s12879-021-06542-5.
lva ARO, Salgado DR, Lopes LPN, Castanheira D, Emmerick ICM and Lima EC (2021) Increased Use of Antibiotics in the Inten- sive Care Unit During Coronavirus Disease (COVID- 19) Pandemic in a Brazilian Hospital. Front. Pharmacol. 12:778386. doi: 10.3389/fphar.2021.778386.
Karaiskos, I., Lagou, S., Pontikis, K., Rapti, V., and Poulakou, G. (2019). The “Old” and the “New” Antibiotics for MDR Gram-Negative Pathogens: For Whom, when, and How. Front. Public Health 7, 151. doi:10.3389/fpubh.2019.00151.
Garcia-Vidal C, Sanjuan G, Moreno-García E, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2021;27(1):83-88. doi:10.1016/j.cmi.2020.07.041.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors hereby transfer, assign, or otherwise convey to RBFHSS: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print republish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to RHFHSS with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Serlf-archiving policy
This journal permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.
