Data from hospitals in Chile, Brazil, and Argentina show substantial increases in intravenous antibiotic use at the beginning of the COVID-19 pandemic, researchers reported this week in Clinical Infectious Diseases.
For the ecological study, a team led by researchers from the US Centers for Disease Control and Prevention (CDC) calculated antibiotic use (AU) rates for intravenous antibiotics in acute care wards at six healthcare facilities (HCFs) in the three countries (two in each country) during two periods: March 2018 to February 2020 (prepandemic) and March 2020 to February 2021 (pandemic). They then compared the median AU during the two period and conducted an interrupted time series analysis to analyze changes in AU during the pandemic. All six HCFs reported having antibiotic stewardship programs.
Compared with the prepandemic period, the median AU rates significantly increased in four of the six HCFs during the pandemic period (percentage change, 6.7% to 35.1%). In the interrupted time series models, five of six HCFs saw significant increases in the use of all antibiotics combined immediately after the onset of the pandemic (immediate effect estimate range, 15.4 to 268), but only one of the five experienced a sustained significant increase in AU rate over time during the pandemic period. The effect of the pandemic onset varied by antibiotic and HCF.
The study authors say the high AU rates observed early in the pandemic are not surprising, given the uncertainty in the appropriate management of COVID-19 patients and concerns about secondary bacterial infections.
Although most increases were observed immediately after the onset of the pandemic, continued monitoring of [antibiotic use] in inpatient settings and understanding trends in antibiotic resistance in South America is important.
"Although most increases were observed immediately after the onset of the pandemic, continued monitoring of AU in inpatient settings and understanding trends in antibiotic resistance in South America is important to inform preventive actions," they wrote. "The COVID-19 pandemic demonstrated the need for HCFs to have pandemic preparedness plans that include implementing or strengthening both diagnostics and ASPs to mitigate overuse of antibiotics."