Durlak Urszula, Kapturkiewicz Cezary, Różańska Anna, Gajda Mateusz, Krzyściak Paweł, Kania Filip, Wójkowska-Mach Jadwiga
Students' Scientific Group of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland.
Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland.
Antibiotics (Basel). 2024 Jul 10;13(7):636. doi: 10.3390/antibiotics13070636.
The COVID-19 pandemic posed numerous challenges to public health systems, particularly in antimicrobial stewardship. This study aimed to assess antibiotic consumption before and during the COVID-19 pandemic to evaluate the effectiveness of the implemented antimicrobial stewardship program.
This retrospective study was carried out at the University Hospital in Krakow, Poland, between 1 January 2019 and 31 December 2020. A total of 80,639 patients were enrolled. Antibiotic usage was measured as the percentage of patients receiving antibiotics and the number of days of therapy (DOTs). The World Health Organization (WHO) methodology and Anatomical Therapeutic Chemical (ATC) codes and AWaRe classification were utilized. The analyzed ATC antibiotic groups included penicillins (J01CA, J01CE, J01CF, J01CR, excluding piperacillin/tazobactam), piperacillin with tazobactam-beta-lactamase inhibitor (J01CR05), third- and fourth-generation cephalosporins (J01DD, J01DE), carbapenems (J01DH), macrolides (J01FA), fluoroquinolones (J01M), colistin (J01XB01), metronidazole (J01XD01) and others (J01DF, J01DI, J01E, J01G, J01XA, J01A). In the AWaRe classification, Access, Watch and Reserve groups of antibiotics were included.
In 2020, 79.2% of COVID-19 patients and 40.1% of non-COVID-19 patients were treated with antibiotics, compared to 28.8% in 2019. Also, in 2020, the antibiotic consumption in non-ICU COVID-19 patients was twice as high as in non-COVID-19 patients: 50.9 vs. 38.5 DOTs/100 patient days (pds). Conversely, in the ICU, antibiotic consumption in COVID-19 patients was 112.1 DOTs/100 pds compared to 248.9 DOTs/100 pds in non-COVID-19 patients. Significant increases were observed in the usage of third- and fourth-generation cephalosporins in 2020. The analysis according to the AWaRe system revealed the highest usage of the Watch group-ranging from 61.9% to 78.7%-and very high usage of the Reserve group-from 5.8% to 11.1%-in non COVID-19 and COVID-19 patients, respectively.
Our findings highlight substantial issues with antibiotic use both before and during the COVID-19 pandemic. The results underscore the urgent need for improved antimicrobial stewardship policy implementation.
新冠疫情给公共卫生系统带来了诸多挑战，尤其是在抗菌药物管理方面。本研究旨在评估新冠疫情之前及期间的抗生素使用情况，以评价所实施的抗菌药物管理计划的有效性。
本回顾性研究于2019年1月1日至2020年12月31日在波兰克拉科夫的大学医院开展。共纳入80639例患者。抗生素使用情况通过接受抗生素治疗的患者百分比和治疗天数（DOTs）来衡量。采用了世界卫生组织（WHO）的方法以及解剖学治疗学化学（ATC）编码和AWaRe分类。分析的ATC抗生素类别包括青霉素类（J01CA、J01CE、J01CF、J01CR，不包括哌拉西林/他唑巴坦）、哌拉西林与β-内酰胺酶抑制剂他唑巴坦（J01CR05）、第三代和第四代头孢菌素（J01DD、J01DE）、碳青霉烯类（J01DH）、大环内酯类（J01FA）、氟喹诺酮类（J01M）、黏菌素（J01XB01）、甲硝唑（J01XD01）及其他（J01DF、J01DI、J01E、J01G、J01XA、J01A）。在AWaRe分类中，纳入了抗生素的“可及”“慎用”和“储备”类别。
2020年，79.2%的新冠患者和40.1%的非新冠患者接受了抗生素治疗，而2019年这一比例为28.8%。此外，2020年，非重症监护病房的新冠患者抗生素使用量是非新冠患者的两倍：50.9 vs. 38.5 DOTs/100患者日（pds）。相反，在重症监护病房，新冠患者的抗生素使用量为112.1 DOTs/100 pds，而非新冠患者为248.9 DOTs/100 pds。2020年第三代和第四代头孢菌素的使用量显著增加。根据AWaRe系统的分析显示，在非新冠患者和新冠患者中，“慎用”类别的使用比例最高，分别为61.9%至78.7%，“储备”类别的使用比例非常高，分别为5.8%至11.1%。
我们的研究结果凸显了新冠疫情之前及期间抗生素使用方面的重大问题。结果强调了迫切需要改进抗菌药物管理政策的实施。
