The impact of the COVID-19 pandemic on antimicrobial usage: An international patient-level cohort study

Refath Farzana; Stephan Jürgen Harbarth; Ly-Mee Yu; Edoardo Carretto; Catrin E Moore; Nicholas Alexander Feasey; Ana C Gales; Ushma Galal; Onder Ergonul; Dongeun Yong; Md Abdullah Yusuf; Balaji Veeraraghavan; Kenneth Chukwuemeka Iregbu; James Anton van Santen; Aghata Cardoso da Silva Ribeiro; Carolina Maria Fankhauser; Chisomo Judith Chilupsya; Christiane Dolecek; Diogo Boldim Ferreira; Fatihan Pinarlik; Jaehyeok Jang; Lal Sude Gücer; Laura Cavazzuti; Marufa Sultana; M D Nazmul Haque; Murielle Galas Haddad; Nubwa Medugu; Philip Ifeanyi Nwajiobi-Princewill; Roberta Marrollo; Rui Zhao; Vivekanandan B Baskaran; J V Peter; Sujith J Chandy; Yamuna Devi Bakthavatchalam; Timothy R Walsh; COVID-/DRI Study Group

doi:10.1093/jacamr/dlaf037

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The impact of the COVID-19 pandemic on antimicrobial usage: An international patient-level cohort study

Authors: Refath Farzana ; Stephan Jürgen Harbarth ; Ly-Mee Yu ; Edoardo Carretto ; Catrin E Moore ; Nicholas Alexander Feasey ; Ana C Gales ; Ushma Galal ; Onder Ergonul ; Dongeun Yong ; Md Abdullah Yusuf ; Balaji Veeraraghavan ; Kenneth Chukwuemeka Iregbu ; James Anton van Santen ; Aghata Cardoso da Silva Ribeiro ; Carolina Maria Fankhauser ; Chisomo Judith Chilupsya ; Christiane Dolecek ; Diogo Boldim Ferreira ; Fatihan Pinarlik ; Jaehyeok Jang ; Lal Sude Gücer ; Laura Cavazzuti ; Marufa Sultana ; M D Nazmul Haque ; Murielle Galas Haddad ; Nubwa Medugu ; Philip Ifeanyi Nwajiobi-Princewill ; Roberta Marrollo ; Rui Zhao ; Vivekanandan B Baskaran ; J V Peter ; Sujith J Chandy ; Yamuna Devi Bakthavatchalam ; Timothy R Walsh ; COVID-/DRI Study Group

Citation: JAC-ANTIMICROBIAL RESISTANCE, Vol.7(2) : dlaf037, 2025-05

Journal Title: JAC-ANTIMICROBIAL RESISTANCE(JAC-Antimicrobial Resistance)

Issue Date: 2025-05

Abstract: Background: This study aimed to evaluate the trends in antimicrobial prescription during the first 1.5 years of COVID-19 pandemic.

Methods: This was an observational, retrospective cohort study using patient-level data from Bangladesh, Brazil, India, Italy, Malawi, Nigeria, South Korea, Switzerland and Turkey from patients with pneumonia and/or acute respiratory distress syndrome and/or sepsis, regardless of COVID-19 positivity, who were admitted to critical care units or COVID-19 specialized wards. The changes of antimicrobial prescription between pre-pandemic and pandemic were estimated using logistic or linear regression. Pandemic effects on month-wise antimicrobial usage were evaluated using interrupted time series analyses (ITSAs).

Results: Antimicrobials for which prescriptions significantly increased during the pandemic were as follows: meropenem in Bangladesh (95% CI: 1.94-4.07) with increased prescribed daily dose (PDD) (95% CI: 1.17-1.58) and Turkey (95% CI: 1.09-1.58), moxifloxacin in Bangladesh (95% CI: 4.11-11.87) with increased days of therapy (DOT) (95% CI: 1.14-2.56), piperacillin/tazobactam in Italy (95% CI: 1.07-1.48) with increased DOT (95% CI: 1.01-1.25) and PDD (95% CI: 1.05-1.21) and azithromycin in Bangladesh (95% CI: 3.36-21.77) and Brazil (95% CI: 2.33-8.42). ITSA showed a significant drop in azithromycin usage in India (95% CI: -8.38 to -3.49 g/100 patients) and South Korea (95% CI: -2.83 to -1.89 g/100 patients) after WHO guidelines v1 release and increased meropenem usage (95% CI: 93.40-126.48 g/100 patients) and moxifloxacin (95% CI: 5.40-13.98 g/100 patients) in Bangladesh and sulfamethoxazole/trimethoprim in India (95% CI: 0.92-9.32 g/100 patients) following the Delta variant emergence.

Conclusions: This study reinforces the importance of developing antimicrobial stewardship in the clinical settings during inter-pandemic periods.