Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times
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 admitt...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-06-01
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| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/12/6/1009 |
| _version_ | 1827738893401718784 |
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| author | Marcella Sibani Lorenzo Maria Canziani Chiara Tonolli Maddalena Armellini Elena Carrara Fulvia Mazzaferri Michela Conti SAVE Working Group Annarita Mazzariol Claudio Micheletto Andrea Dalbeni Domenico Girelli Evelina Tacconelli |
| author_facet | Marcella Sibani Lorenzo Maria Canziani Chiara Tonolli Maddalena Armellini Elena Carrara Fulvia Mazzaferri Michela Conti SAVE Working Group Annarita Mazzariol Claudio Micheletto Andrea Dalbeni Domenico Girelli Evelina Tacconelli |
| author_sort | Marcella Sibani |
| collection | DOAJ |
| description | 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; <i>p</i> < 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; <i>p</i> < 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. |
| first_indexed | 2024-03-11T02:50:27Z |
| format | Article |
| id | doaj.art-2be12de6d02e4b8ea7052492f8573358 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-11T02:50:27Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-2be12de6d02e4b8ea7052492f85733582023-11-18T09:00:46ZengMDPI AGAntibiotics2079-63822023-06-01126100910.3390/antibiotics12061009Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard TimesMarcella Sibani0Lorenzo Maria Canziani1Chiara Tonolli2Maddalena Armellini3Elena Carrara4Fulvia Mazzaferri5Michela Conti6SAVE Working GroupAnnarita Mazzariol7Claudio Micheletto8Andrea Dalbeni9Domenico Girelli10Evelina Tacconelli11Infectious Diseases Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, ItalyDivision of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, 37129 Verona, ItalyDepartment of Pharmacy, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, ItalyDivision of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, 37129 Verona, ItalyDivision of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, 37129 Verona, ItalyInfectious Diseases Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, ItalyDivision of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, 37129 Verona, ItalyMicrobiology and Virology Section, Department of Diagnostic and Public Health, University of Verona, 37129 Verona, ItalyRespiratory Unit, Cardio-Thoracic Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, ItalySection General Medicine C and Liver Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, ItalyDepartment of Medicine, Section of Internal Medicine D, University of Verona, 37129 Verona, ItalyDivision of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, 37129 Verona, ItalyBackground: 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; <i>p</i> < 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; <i>p</i> < 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.https://www.mdpi.com/2079-6382/12/6/1009COVID-19antimicrobial stewardshipantibiotic consumption |
| spellingShingle | Marcella Sibani Lorenzo Maria Canziani Chiara Tonolli Maddalena Armellini Elena Carrara Fulvia Mazzaferri Michela Conti SAVE Working Group Annarita Mazzariol Claudio Micheletto Andrea Dalbeni Domenico Girelli Evelina Tacconelli Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times Antibiotics COVID-19 antimicrobial stewardship antibiotic consumption |
| title | Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times |
| title_full | Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times |
| title_fullStr | Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times |
| title_full_unstemmed | Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times |
| title_short | Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times |
| title_sort | antimicrobial stewardship in covid 19 patients those who sow will reap even through hard times |
| topic | COVID-19 antimicrobial stewardship antibiotic consumption |
| url | https://www.mdpi.com/2079-6382/12/6/1009 |
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