Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil.
Laboratory of Clinical Research in Intensive Care Medicine, National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil.
J Antimicrob Chemother. 2023 Mar 2;78(3):840-849. doi: 10.1093/jac/dkad025.
To understand differences in antimicrobial use between COVID-19 and non-COVID-19 patients. To compare two metrics commonly used for antimicrobial use: Defined Daily Dose (DDD) and Days of Therapy (DOT). To analyse the order in which antimicrobials were prescribed to COVID-19 patients using process mining techniques.
We analysed data regarding all ICU admissions from 1 January 2018 to 14 September 2020, in 17 Brazilian hospitals. Our main outcome was the antimicrobial use estimated by the DDD and DOT (Days of Therapy). We compared clinical characteristics and antimicrobial consumption between COVID-19 and non-COVID-19 patients. We used process mining to evaluate the order in which the antimicrobial schemes were prescribed to each COVID-19 patient.
We analysed 68 405 patients admitted before the pandemic, 12 319 non-COVID-19 patients and 3240 COVID-19 patients. Comparing those admitted during the pandemic, the COVID-19 patients required advanced respiratory support more often (42% versus 12%). They also had longer ICU length of stay (6 versus 3 days), higher ICU mortality (18% versus 5.4%) and greater use of antimicrobials (70% versus 39%). Most of the COVID-19 treatments started with penicillins with ß-lactamase inhibitors (30%), third-generation cephalosporins (22%), or macrolides in combination with penicillins (19%).
Antimicrobial prescription increased in Brazilian ICUs during the COVID-19 pandemic, especially during the first months of the epidemic. We identified greater use of broad-spectrum antimicrobials by COVID-19 patients. Overall, the DDD metric overestimated antimicrobial use compared with the DOT metric.
了解 COVID-19 患者和非 COVID-19 患者之间抗菌药物使用的差异。比较两种常用于抗菌药物使用的指标：限定日剂量（DDD）和治疗日数（DOT）。使用流程挖掘技术分析 COVID-19 患者处方中抗菌药物的使用顺序。
我们分析了 2018 年 1 月 1 日至 2020 年 9 月 14 日期间，17 家巴西医院的所有 ICU 入院数据。我们的主要结局是通过 DDD 和 DOT（治疗日数）估计的抗菌药物使用。我们比较了 COVID-19 患者和非 COVID-19 患者的临床特征和抗菌药物使用情况。我们使用流程挖掘技术评估每个 COVID-19 患者的抗菌药物方案的使用顺序。
我们分析了大流行前收治的 68405 例患者、12319 例非 COVID-19 患者和 3240 例 COVID-19 患者。与大流行期间收治的患者相比，COVID-19 患者更常需要高级呼吸支持（42%比 12%）。他们的 ICU 住院时间也更长（6 天比 3 天），ICU 死亡率更高（18%比 5.4%），抗菌药物使用更多（70%比 39%）。大多数 COVID-19 治疗开始时使用了含β-内酰胺酶抑制剂的青霉素（30%）、第三代头孢菌素（22%）或与青霉素联合使用的大环内酯类药物（19%）。
在 COVID-19 大流行期间，巴西 ICU 中抗菌药物的使用增加，尤其是在疫情的头几个月。我们发现 COVID-19 患者更广泛地使用了广谱抗菌药物。总的来说，DDD 指标比 DOT 指标高估了抗菌药物的使用。
