Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA; Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA.
University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA.
Int J Antimicrob Agents. 2021 Dec;58(6):106453. doi: 10.1016/j.ijantimicag.2021.106453. Epub 2021 Oct 13.
This retrospective cohort study examined the impact of the pandemic on antimicrobial use (AU) in South Carolina hospitals.
Antimicrobial use in days of therapy (DOT) per 1000 days-present was evaluated in 17 hospitals in South Carolina. Matched-pairs mean difference was used to compare AU during the pandemic (March-June 2020) with that during the same months in 2019 in hospitals that did and did not admit patients with COVID-19.
There was a 6.6% increase in overall AU in the seven hospitals that admitted patients with COVID-19 (from 530.9 to 565.8; mean difference (MD) 34.9 DOT/1000 days-present; 95% CI 4.3, 65.6; P = 0.03). There was no significant change in overall AU in the remaining 10 hospitals that did not admit patients with COVID-19 (MD 6.0 DOT/1000 days-present; 95% CI -55.5, 67.6; P = 0.83). Most of the increase in AU in the seven hospitals that admitted patients with COVID-19 was observed in broad-spectrum antimicrobial agents. A 16.4% increase was observed in agents predominantly used for hospital-onset infections (from 122.3 to 142.5; MD 20.1 DOT/1000 days-present; 95% CI 11.1, 29.1; P = 0.002). There was also a 9.9% increase in the use of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents (from 66.7 to 73.3; MD 6.6 DOT/1000 days-present; 95% CI 2.3, 10.8; P = 0.01).
The COVID-19 pandemic appears to drive overall and broad-spectrum antimicrobial use in South Carolina hospitals admitting patients with COVID-19. Additional antimicrobial stewardship resources are needed to curtail excessive antimicrobial use in hospitals to prevent subsequent increases in antimicrobial resistance and Clostridioides difficile infection rates, given the continuing nature of the pandemic.
本回顾性队列研究调查了大流行对南卡罗来纳州医院抗菌药物使用（AU）的影响。
评估了南卡罗来纳州 17 家医院每 1000 天治疗日（DOT）的抗菌药物使用情况。采用匹配对均值差比较了在有和没有收治 COVID-19 患者的医院中，大流行期间（2020 年 3 月至 6 月）与 2019 年同期的 AU。
在收治 COVID-19 患者的 7 家医院中，AU 总体增加了 6.6%（从 530.9 增至 565.8；平均差值（MD）34.9 DOT/1000 治疗日；95%CI 4.3，65.6；P=0.03）。在没有收治 COVID-19 患者的其余 10 家医院中，AU 总体无显著变化（MD 6.0 DOT/1000 治疗日；95%CI -55.5，67.6；P=0.83）。在收治 COVID-19 患者的 7 家医院中，AU 增加主要发生在广谱抗菌药物中。主要用于医院获得性感染的药物（从 122.3 增至 142.5；MD 20.1 DOT/1000 治疗日；95%CI 11.1，29.1；P=0.002）的使用增加了 16.4%。抗耐甲氧西林金黄色葡萄球菌（MRSA）药物的使用也增加了 9.9%（从 66.7 增至 73.3；MD 6.6 DOT/1000 治疗日；95%CI 2.3，10.8；P=0.01）。
COVID-19 大流行似乎导致南卡罗来纳州收治 COVID-19 患者的医院 AU 总体增加和广谱抗菌药物使用增加。鉴于大流行的持续性质，需要额外的抗菌药物管理资源来遏制医院过度使用抗菌药物，以防止随后的抗菌药物耐药性和艰难梭菌感染率增加。
