Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital

Alice Ramos Oliveira Silva; Diamantino Ribeiro Salgado; Luis Phillipe Nagem Lopes; Débora Castanheira; Isabel Cristina Martins Emmerick; Elisangela Costa Lima

doi:10.3389/fphar.2021.778386

Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital

Front Pharmacol. 2021 Dec 10:12:778386. doi: 10.3389/fphar.2021.778386. eCollection 2021.

Authors

Alice Ramos Oliveira Silva¹, Diamantino Ribeiro Salgado², Luis Phillipe Nagem Lopes¹, Débora Castanheira³, Isabel Cristina Martins Emmerick⁴, Elisangela Costa Lima¹

Affiliations

¹ Pharmacy School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
² Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
³ National School of Public Health Sergio Arouca, Rio de Janeiro, Brazil.
⁴ Division of Thoracic Surgery, Department of Surgery, UMass Chan Medical School, Worcester, MA, United States.

Abstract

Background: Microbial drug resistance is one of the biggest public health problems. Antibiotic consumption is an essential factor for the emergence and spread of multiresistant bacteria. Therefore, we aimed to analyze the antibiotics consumption in the Intensive Care Unit (ICU), identifying trends in the antibiotics use profile and microbiological isolates throughout the COVID-19 pandemic. Methods: We performed this retrospective observational study in intensive care units of a Brazilian tertiary hospital from January 2019 to December 2020. The primary outcome was antimicrobial consumption in the ICU, measured by defined daily doses (DDDs) per 100 bed-days. As a secondary outcome, bacterial infections (microbiological isolates) were calculated in the same fashion. Outcomes trends were analyzed using Joinpoint regression models, considering constant variance (homoscedasticity) and first-order autocorrelation assumptions. A monthly percent change (MPC) was estimated for each analyzed segment. Results: Seven thousand and nine hundred fifty-three patients had data available on prescribed and received medications and were included in the analyses. Overall, the use of antibiotics increased over time in the ICU. The reserve group (World Health Organization Classification) had an increasing trend (MPC = 7.24) from February to April 2020. The azithromycin consumption (J01FA) increased rapidly, with a MPC of 5.21 from January to April 2020. Polymyxin B showed a relevant increase from March to June 2020 (MPC = 6.93). The peak of the antibiotic consumption of Reserve group did not overlap with the peak of the pathogenic agents they are intended to treat. Conclusion: Overall antimicrobial consumption in ICU has increased in the context of the COVID-19 pandemic. The peaks in the antimicrobial's use were not associated with the rise of the pathogenic agents they intended to treat, indicating an empirical use, which is especially concerning in the context of treating multidrug-resistant (MDR) infections. This fact may contribute to the depletion of the therapeutic arsenal for MDR treatment.

Keywords: COVID-19; anti-infective agents; bacterial; bacterial infection; coinfection; drug resistance; intensive care units.