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Antibiotics
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Antimicrobial Use and Stewardship during the COVID-19 Era, 2nd Edition
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Antimicrobial Use and Stewardship during the COVID-19 Era, 2nd Edition

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 6970

Special Issue Editors

Dr. Lorenzo Onorato

E-Mail Website
Guest Editor
Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
Interests: antimicrobial stewardship; viral hepatitis; HBV; HCV; HIV
Special Issues, Collections and Topics in MDPI journals
Dr. Marianna Meschiari

E-Mail Website
Guest Editor
Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, 41122 Modena, Italy
Interests: infectious diseases control and prevention; drug resistance; infectious diseases surveillance; infectious diseases transmission
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

After almost two years of the coronavirus disease 2019 (COVID-19) pandemic, every healthcare system has implemented profound changes to prevent the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has had a double impact on antimicrobial consumption (AC) and, consequently, on antibiotic resistance (AMR), declared by the WHO as one of the top ten global public health threats facing humanity in 2019.

Concerns about the impact of the COVID-19 pandemic on antimicrobial consumption have emerged as a priority, particularly long-term monitoring of the potential increased and inappropriate use of antimicrobials due to a lack of antimicrobial stewardship programs (ASPs), resulting in increased AMR. In this ever-changing and rapidly evolving post-pandemic scenario, warnings have arisen regarding unsupervised antibiotic use and the potential consequences for the development and spread of AMR, with long-term implications that cannot be totally predicted.

Although surveillance reports are encouraging, limited studies have been performed to investigate the long-term impact of COVID-19 on ASPs. Considering the success of the previous volume, the aim of this new Special Issue is to provide new evidence and extend data-based research activities on strengthening ASPs, which were greatly loosened during the pandemic.

Dr. Lorenzo Onorato
Dr. Marianna Meschiari
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • antimicrobial consumption
  • COVID-19 pandemic

Related Special Issue

Published Papers (5 papers)

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Research

15 pages, 2317 KiB  
Article
Secondary and Co-Infections in Hospitalized COVID-19 Patients: A Multicenter Cross-Sectional Study in Malaysia
by Siti Roszilawati Ramli, Fashihah Sherina Abdul Hadi, Nur Asyura Nor Amdan, Insyirah Husna Kamaradin, Noraliza Zabari, Saraswathiy Maniam, Nur Suffia Sulaiman, Sumarni Ghazali, Zamtira Seman, Rohaidah Hashim and Norazah Ahmad
Antibiotics 2023, 12(10), 1547; https://doi.org/10.3390/antibiotics12101547 - 16 Oct 2023
Viewed by 1148
Abstract
Bacterial and fungal secondary and co-infections are commonly identified with viral respiratory infections. This study was undertaken to determine the incidence and factors associated with bacterial and fungal infections in patients with COVID-19 as well as antibiotics prescription patterns within the first and [...] Read more.
Bacterial and fungal secondary and co-infections are commonly identified with viral respiratory infections. This study was undertaken to determine the incidence and factors associated with bacterial and fungal infections in patients with COVID-19 as well as antibiotics prescription patterns within the first and second waves of the outbreak in Malaysia. Clinical records of 3532 COVID-19 patients admitted to hospitals in Malaysia between 4 February and 4 August 2020 were analyzed. Co-morbidities, clinical features, investigations, treatment, and complications were captured using the REDCap database. Culture and sensitivity test results were retrieved from the WHONET database. Univariate and multivariate regression analyses were used to identify associated determinants. A total of 161 types of bacterial and fungal infections were found in 81 patients, i.e., 2.3%. The most common bacterial cultures were Gram-negative, i.e., Pseudomonas aeruginosa (15.3%) and Klebsiella pneumoniae (13.9%). The most common fungal isolate was Candida albicans (41.2%). Augmentin, ceftriaxone, tazocin, meropenem, and azithromycin were the five most frequently prescribed antibiotics. The latter four were classified under the “Watch” category in the WHO AwaRe list. Our data showed that bacterial and fungal secondary and co-infections were frequently found in severely ill COVID-19 patients and were associated with a higher mortality rate. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era, 2nd Edition)
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13 pages, 2230 KiB  
Article
How Did COVID-19 Impact the Antimicrobial Consumption and Bacterial Resistance Profiles in Brazil?
by Natália Cassago Marcos Massarine, Gleyce Hellen de Almeida de Souza, Isadora Batista Nunes, Túlio Máximo Salomé, Marcelo dos Santos Barbosa, Izadora Faccin, Luana Rossato and Simone Simionatto
Antibiotics 2023, 12(9), 1374; https://doi.org/10.3390/antibiotics12091374 - 28 Aug 2023
Cited by 1 | Viewed by 1310
Abstract
The indiscriminate use of antibiotics has favored the selective pressure of multidrug resistance among microorganisms. This research evaluated the pattern of antibiotic prescriptions among the Brazilian population between January 2018 and December 2021. Additionally, the study sought to analyze the incidence rates of [...] Read more.
The indiscriminate use of antibiotics has favored the selective pressure of multidrug resistance among microorganisms. This research evaluated the pattern of antibiotic prescriptions among the Brazilian population between January 2018 and December 2021. Additionally, the study sought to analyze the incidence rates of central line-associated bloodstream infection (CLABSI) and examine the profiles of antibiotic resistance. We assessed the hospital and community antimicrobial consumption from the National Health Surveillance Agency Database and correlated it to microorganisms. The consumption of antimicrobials in the hospital environment increased by 26% in 2021, highlighting polymyxin B, which increased by 204%. In 2021, 244,266 cases of CLABSI were reported, indicating a nosocomial infection rate of 7.9%. The rate of resistance to polymyxin B was higher in Pseudomonas aeruginosa (1400%) and Klebsiella pneumoniae (514%). Azithromycin emerged as the predominant antibiotic utilized within the community setting, accounting for 24% of the overall consumption. Pearson’s correlation analysis revealed a significant and positive correlation (r = 0.71) between the elevated usage of azithromycin and the incidence of COVID-19. Our results indicate an increase in antimicrobial consumption during the COVID-19 pandemic and reinforce the fact that the misuse of antimicrobials may lead to an expansion in antimicrobial resistance. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era, 2nd Edition)
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12 pages, 284 KiB  
Article
Prevalence and Epidemiological and Clinical Features of Bacterial Infections in a Large Cohort of Patients Hospitalized for COVID-19 in Southern Italy: A Multicenter Study
by Lorenzo Onorato, Federica Calò, Paolo Maggi, Enrico Allegorico, Ivan Gentile, Vincenzo Sangiovanni, Vincenzo Esposito, Chiara Dell’Isola, Giosuele Calabria, Raffaella Pisapia, Angelo Salomone Megna, Alfonso Masullo, Elio Manzillo, Grazia Russo, Roberto Parrella, Giuseppina Dell’Aquila, Michele Gambardella, Felice Di Perna, Mariantonietta Pisaturo and Nicola Coppola
Antibiotics 2023, 12(7), 1124; https://doi.org/10.3390/antibiotics12071124 - 29 Jun 2023
Viewed by 1038
Abstract
Background: The aim of this study was to evaluate the prevalence of bacterial infections and antimicrobial prescriptions in a large cohort of COVID-19 patients and to identify the independent predictors of infection and antibiotic prescription. Methods: All consecutive patients hospitalized for COVID-19 from [...] Read more.
Background: The aim of this study was to evaluate the prevalence of bacterial infections and antimicrobial prescriptions in a large cohort of COVID-19 patients and to identify the independent predictors of infection and antibiotic prescription. Methods: All consecutive patients hospitalized for COVID-19 from March 2020 to May 2021 at 1 of the 17 centers participating in the study were included. All subjects showing a clinical presentation consistent with a bacterial infection with microbiological confirmation (documented infection), and/or a procalcitonin value >1 ng/mL (suspected infection) were considered as having a coinfection (if present at admission) or a superinfection (if acquired after at least 48 h of hospital stay). Results: During the study period, of the 1993 patients, 42 (2.1%) presented with a microbiologically documented infection, including 17 coinfections and 25 superinfections, and 267 (13.2%) a suspected infection. A total of 478 subjects (24.5%) received an antibacterial treatment other than macrolides. No independent predictors of confirmed or suspected bacterial infection were identified. On the contrary, being hospitalized during the second wave of the pandemic (OR 1.35, 95% CI 1.18–1.97, p = 0.001), having a SOFA score ≥3 (OR 2.05, 95% CI 1.53–2.75, p < 0.001), a severe or critical disease (OR 1.66, 95% CI 1.24–2.23, p < 0.001), and a high white blood cell count (OR 1.03, 95% CI 1.004–1.06, p = 0.023) were all independently related to having received an antimicrobial prescription. Conclusions: Our study reported a high rate of antimicrobial prescriptions despite a limited number of documented or suspected bacterial infections among the large cohort of hospitalized COVID-19 patients. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era, 2nd Edition)
11 pages, 797 KiB  
Article
Rapid Decrease in Fluoroquinolones Consumption following Implementation of a Simple Antimicrobial Stewardship Bundled Intervention in a University Hospital during the COVID-19 Pandemic
by Raffaela Olivieri, Paola Vannini, Alice Corzani, Maria Teresa Bianco, Federico Franchi, Maria Grazia Cusi, Sabino Scolletta, Fabio Arena, Claudia Basagni, Roberto Gusinu and Mario Tumbarello
Antibiotics 2023, 12(4), 694; https://doi.org/10.3390/antibiotics12040694 - 02 Apr 2023
Viewed by 1280
Abstract
Fluoroquinolones (FQs) represent an class of antibiotics of medical importance, but their use has been restricted due to their ecologic impact and associated side effects. The reduction of FQs use is an important goal of antimicrobial stewardship programs (ASP). This work describes an [...] Read more.
Fluoroquinolones (FQs) represent an class of antibiotics of medical importance, but their use has been restricted due to their ecologic impact and associated side effects. The reduction of FQs use is an important goal of antimicrobial stewardship programs (ASP). This work describes an ASP focused on overall antibiotics and FQs consumption reduction. From January 2021, an ASP was implemented in a 700-bed teaching hospital. The ASP was based on: (i) antibiotics consumption monitoring system (DDD/100 bed days); (ii) mandatory antibiotic prescription-motivation (using a dedicated informatic format) with the goal of >75% of motivated prescriptions; and (iii) data feedback and training on FQs use indications. We evaluated the impact of the intervention on overall systemic antibiotics and FQs consumption according to the objectives posed by Italian PNCAR (National Action Plan on Antimicrobial Resistance). A decrease of 6.6% in antibiotic use was observed (2019 vs. 2021). Notably, the FQs consumption fell by 48.3% from 7.1 DDD/100 bd in 2019 to 3.7 DDD/100 bd in 2021 (p < 0.001). After six months of mandatory antibiotic prescription-indication, all units achieved the target set. The study suggests that a simple, bundled ASP intervention can be rapidly effective obtaining the objectives of PNCAR on the reduction of overall antibiotics and FQs consumption. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era, 2nd Edition)
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12 pages, 1713 KiB  
Article
Impact of COVID-19 Pandemic in Antibiotic Consumption in Navarre (Spain): An Interrupted Time Series Analysis
by Natalia Alzueta, Amaya Echeverría, Patricia García, Lorea Sanz, Alberto Gil-Setas, Xabier Beristain, Pablo Aldaz and Javier Garjón
Antibiotics 2023, 12(2), 318; https://doi.org/10.3390/antibiotics12020318 - 03 Feb 2023
Cited by 3 | Viewed by 1719
Abstract
On 11 March 2020, the World Health Organization declared coronavirus disease 19 (COVID-19) a global pandemic. This exceptional situation changed the world not only in terms of mortality and morbidity, but also in terms of epidemiology and health system resources consumption. The objective [...] Read more.
On 11 March 2020, the World Health Organization declared coronavirus disease 19 (COVID-19) a global pandemic. This exceptional situation changed the world not only in terms of mortality and morbidity, but also in terms of epidemiology and health system resources consumption. The objective of this work was to analyze the consumption of antibiotics during the period around the pandemic in our region. A drug utilization study was performed comparing the antibiotic consumption in the community during the years 2018, 2019, 2020, and 2021. Quarterly antibiotic use (defined daily doses (DDD) per 1000 inhabitants per day (DID)) and number of patients treated were the outcomes. Interrupted time series regression analysis was performed to estimate the statistical significance of the change in level of consumption before and after the COVID-19 pandemic. The drop of global antibiotic consumption was statistically significant, both in number of patients and in DID when analyzing pre-pandemic period versus pandemic period. The use of strategic antibiotics for respiratory infections such as amoxicillin, amoxicillin-clavulanic acid, and levofloxacin also decreased significantly. Seasonal pattern of use of antibiotics disappeared due to the global measures imposed over the world to work against COVID-19. Full article
(This article belongs to the Special Issue Antimicrobial Use and Stewardship during the COVID-19 Era, 2nd Edition)
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