Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon.
Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
J Infect Public Health. 2024 Feb;17(2):254-262. doi: 10.1016/j.jiph.2023.12.007. Epub 2023 Dec 14.
Antimicrobial Resistance, a global concern, worsened with the COVID-19 pandemic that caused a surge of critically ill patients, increased antimicrobial consumption, and the spread of infections with multidrug-resistant organisms (MDROs). Antimicrobial Stewardship Programs (ASP) aim to optimize antimicrobial utilization to fight resistance. We aim to describe the ASP experience and to study antimicrobial consumption and MDRO rates among COVID-19 patients at a tertiary care center in Beirut.
We compiled the ASP interventions, defined as ASP team recommendations, from January 2019 until December 2021. Data on antimicrobial consumption, expressed as a defined daily dose (DDD) per 100 patient days, was collected per quarter for all antimicrobials and restricted antimicrobials per ASP guidance. Our primary objective was to report on the ASP experience, and the secondary objective was to reflect on the rates of MDROs among hospitalized COVID-19 patients with respiratory or bloodstream bacterial co-infections between March 2020 and September 2021.
9922 ASP interventions were documented during this study period, with a noticeable correlation between COVID-19 surges in Lebanon and the number of ASP interventions. Acceptance rates for these recommendations improved over time, with a noticeable decrease in the proportion of interventions related to de-escalation and discontinuation of broad-spectrum antimicrobials. We noted an increase in all antimicrobial consumption after the onset of the pandemic, peaking in Q4 2020 (142.8 DDD of anti-infectives/100 patient days) and Q1 2021 (79.1 DDD of restricted anti-infectives/100 patient days). As expected, MDROs, particularly ESKAPE organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Carbapenem-resistant Enterobacteriaceae) accounted for 24% of isolates obtained from this cohort.
This study highlights the experience of the ASP as we adapted to the COVID-19 pandemic. The ASP team maintained its operations and continued to monitor antibiotic consumption and provide recommendations to limit antibiotic misuse in an effort to mitigate the impact of the pandemic on antimicrobial resistance.
抗菌药物耐药性是一个全球性问题，随着 COVID-19 大流行，病情危重的患者激增，抗菌药物使用量增加，以及耐多药生物体（MDRO）感染的传播，情况进一步恶化。抗菌药物管理计划（ASP）旨在优化抗菌药物的使用以对抗耐药性。我们旨在描述贝鲁特一家三级保健中心的 ASP 经验，并研究 COVID-19 患者的抗菌药物使用情况和 MDRO 发生率。
我们从 2019 年 1 月至 2021 年 12 月汇编了 ASP 干预措施，将其定义为 ASP 小组的建议。每季度收集所有抗菌药物和根据 ASP 指南限制使用的抗菌药物的抗菌药物使用量数据，以每 100 个患者天的限定日剂量（DDD）表示。我们的主要目标是报告 ASP 的经验，次要目标是反映 2020 年 3 月至 2021 年 9 月住院 COVID-19 患者合并呼吸道或血流细菌合并感染时 MDRO 的发生率。
在研究期间共记录了 9922 项 ASP 干预措施，黎巴嫩 COVID-19 疫情的发展与 ASP 干预措施的数量之间存在明显的相关性。随着时间的推移，这些建议的接受率有所提高，与降阶梯和停止使用广谱抗菌药物相关的干预措施比例明显下降。我们注意到大流行开始后所有抗菌药物的使用量增加，在 2020 年第四季度（每 100 个患者天的抗感染药物使用量为 142.8 DDD）和 2021 年第一季度（每 100 个患者天的限制使用抗感染药物为 79.1 DDD）达到峰值。正如预期的那样，MDRO，特别是 ESKAPE 生物体（屎肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和耐碳青霉烯类肠杆菌科）占该队列中分离物的 24%。
本研究强调了 ASP 的经验，因为我们适应了 COVID-19 大流行。ASP 小组保持了运作，并继续监测抗生素的使用情况并提供建议，以限制抗生素的滥用，努力减轻大流行对抗菌药物耐药性的影响。
