Trends in antibiotic usage among inpatients in South America during COVID-19 pandemic

By Tarun Sai LomteReviewed by Benedette Cuffari, M.Sc.Jul 12 2023

A recent study published in Clinical Infectious Diseases evaluates how the coronavirus disease 2019 (COVID-19) pandemic impacted antibiotic use (AU) in healthcare facilities (HCFs) throughout South America.

Study: Trends in Inpatient Antibiotic Use Among Adults Hospitalized During the Coronavirus Disease 2019 Pandemic in Argentina, Brazil, and Chile, 2018–2021. Image Credit: Fahroni / Shutterstock.com

The overuse of antibiotics during the pandemic

Increased AU has been observed in several countries since the COVID-19 pandemic, despite low rates of bacterial and secondary infections. A recent meta-analysis revealed that up to 75% of COVID-19 patients were prescribed antibiotics, despite the rate of bacterial co-infections being only 8.6%. Although COVID-19 symptoms appear similar to bacterial pneumonia/sepsis symptoms, antibiotics are ineffective due to the viral etiology.

Antibiotic resistance is a significant global public health threat, with antibiotic overuse being the leading cause of resistance. A recent report highlighted considerable increases in antibiotic-resistant infections throughout the COVID-19 pandemic.

Latin America has been one of the most impacted regions by COVID-19. To date, only a few studies have described how the pandemic affected AU, with limited data available regarding AU throughout South American HCFs.

About the study

In the present study, researchers evaluate how the COVID-19 pandemic affected AU across HCFs in Brazil, Chile, and Argentina. To this end, AU was examined in six HCFs between March 2018 and February 2021, which were classified into pre-pandemic and pandemic periods. Patients aged 15 years or older admitted to acute care wards were included in the current study.

A comprehensive survey of HCFs was conducted to examine changes in practices over time. AU data were obtained from dispensing records.

Treatment guidelines for managing sepsis, as well as hospital- and community-acquired pneumonia, were available for two, four, and three HCFs, respectively. Preferred and alternative regimens of antibiotics for these conditions were also obtained.

Several antibiotics were included in the analysis, which included ceftolozane-tazobactam, ceftazidime-avibactam, colistin, polymyxin B, linezolid, vancomycin, ampicillin-sulbactam, piperacillin-tazobactam, azithromycin, ceftaroline, cefotaxime, cefepime, ceftazidime, ceftriaxone, moxifloxacin, levofloxacin, ertapenem, meropenem, and imipenem.

Analyses were stratified by all antibodies, ceftriaxone, and those showing activity against methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. The impact of the COVID-19 pandemic on AU across HCFs was estimated from relative median differences between the two periods. Interrupted-time series analyses were performed to examine temporal changes in AU due to COVID-19.

Study findings

Two HCFs were public and four were private. Intensive care unit (ICU) admissions increased by up to 633% across all facilities during the COVID-19 pandemic. Similarly, ventilator use increased in five facilities by up to 317%.

All facilities had a pre-pandemic antibiotic stewardship program. To this end, no changes were reported in stewardship practices across four HCFs.

Three facilities reported antibiotic shortages, with all HCFs experiencing shortages in healthcare personnel. Delays in antibiotic susceptibility testing increased in two facilities.

The median rate of AU increased in four HCFs during the pandemic relative to the pre-pandemic period, with higher rates of AU during months when COVID-19 cases surged. The rates of AU in ICUs increased in one HCF and decreased in two facilities during the pandemic.

During the pandemic, three HCFs reported a significantly increased use of ceftriaxone. Likewise, the use of this antibiotic increased in ICUs in two facilities and decreased in ICUs in two other HCFs.

The increased use of β-lactam antibiotics with anti-P. aeruginosa activity was observed in three HCFs, with one facility reporting lower usage, whereas ICUs in two facilities reported increased usage. The use of antibiotics with anti-MRSA activity increased in three HCFs and ICUs in one HCF.

The public HCF in Brazil reported increased use of all antibiotics throughout the pandemic. Five HCFs experienced an increase in AU immediately after the pandemic started; however, only one HCF reported a sustained increase in AU rates throughout the pandemic. Notwithstanding the increases early in the pandemic, AU rates significantly declined over time in two facilities.

Conclusions

The increased rates of AU during the COVID-19 pandemic among inpatients in South America are consistent with findings from other regions. In some facilities, AU rates peaked when COVID-19 cases increased significantly, with all facilities reporting increased ICU admissions.

Importantly, these analyses were not stratified by bacterial infection, COVID-19, and severity of illness. Additionally, it was unclear whether the increases in AU rates were driven by hospitalized COVID-19 patients or overall patient populations.