Impact of the COVID-19 pandemic on antibiotic utilization in a tertiary hospital.

INTRODUCTION: This study aimed to determine the use of antimicrobial drugs during the second year of the coronavirus disease 2019 (COVID-19) pandemic, and evaluate the pandemic`s impact on antibiotic use by comparing with the pre-pandemic period. METHODOLOGY: The study was a retrospective point prevalence study. Patients aged ≥ 18 years, who received antibiotics in our hospital between 11 February 2020. and 3 January 2022 were evaluated. The antibiotics were categorized according to the 2021 Access/Watch/Reserve (AWARe) classification. Compliance with recommendations from infectious diseases (ID) physicians, and reasons for inappropriate treatment were evaluated. RESULTS: Among the hospitalized patients, 323 (36.4%) during the pre-pandemic days (PPD), and 361 (50.1%) during pandemic days (PD), used at least one antimicrobial drug (p < 0.001). The most frequently used antibiotics during PPD and PD were piperacillin, tazobactam, and imipenem/meropenem. The use of the "Access" group antibiotics decreased in the PD, while the use of the "Watch" and "Reserve" groups increased (p = 0.034). There was 100% (n = 209) compliance with ID consultation in the PPD, and 91.9% (n = 227) in the PD (p < 0.001). In the PPD, 64 (19.8%). of the treatments received by inpatients were inappropriate, and during the PD 100 (27.7%) were inappropriate (p = 0.016). CONCLUSIONS: The pandemic led to an increase in the overuse and inappropriate use of antimicrobial drugs, particularly in the Watch and Reserve groups, in both COVID-19 and non-COVID-19 clinics. There was a notable transition towards the increased utilization of broad-spectrum antibiotics during the pandemic.

Six-year evaluation of device-associated nosocomial infections in intensive care units.

INTRODUCTION: Invasive device-associated nosocomial infections commonly occur in intensive care units (ICUs). These infections include intravascular catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). This study aimed to evaluate the factors associated with invasive device-associated nosocomial infections based on the underlying diseases of the patients and antibiotic resistance profiles of the pathogens causing the infections detected in the ICU in our hospital over a five-year period. METHODOLOGY: Invasive device-associated infections (CRBSI, VAP, and CAUTI) were detected retrospectively by the laboratory- and clinic-based active surveillance system according to the criteria of the US Centers for Disease Control and Prevention (CDC) in patients hospitalized in the ICU of the tertiary hospital between 1 January 2018 and 30 June 2023. RESULTS: A total of 425 invasive device-associated nosocomial infections and 441 culture results were detected (179 CRBSI, 176 VAP, 70 CAUTI). Out of them, 57 (13.4%) patients had hematological malignancy, 145 (34.1%) had solid organ malignancy, and 223 (52.5%) had no histopathologic diagnosis of any malignancy. An increase in extended-spectrum beta lactamase (ESBL) and carbapenem resistance in pathogens was detected during the study period. CONCLUSIONS: Antibiotic resistance of the Gram-negative bacteria associated with invasive device-associated infections increased during the study period. Antimicrobial stewardship will reduce rates of nosocomial infections, reduce mortality, and shorten hospital stay. Long-term catheterization and unnecessary antibiotic use should be avoided.