Analysis of antibacterial agents consumption in a Brazilian southeastern hospital complex from 2018 to 2021

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DOI:

https://doi.org/10.1590/

Keywords:

Antibacterials agents, Defined daily dose, Hospitals, Antibiotics, Drug resistance

Abstract

Healthcare during the COVID-19 pandemic may have led to the inappropriate use of antimicrobial agents and contributed to elevated multidrug resistance. The aim of this study was to analyze the consumption of antibacterial agents at a hospital complex from 2018 to 2021. Drug utilization study using antibacterial agents consumption data. The groups of antibacterial agents most consumed in the hospital complex were carbapenems, penicillins + beta-lactamase inhibitors, beta-lactamase-resistant penicillins, glycopeptides, and fluoroquinolones. The drugs with a compound annual growth rate that increased by more than 20% from 2018 to 2021 were amikacin (50.12%), benzylpenicillin (24.33%), oral clarithromycin (51.06%), daptomycin (34.38%), polymyxin B (20.85%), and tigecycline (41.49%). According to the AWaRE classification, the antibacterial agents from the Watch group subjected to AWaRE exhibited increased consumption in all years of the study. On the other hand, there was a reduction in the access category. In turn, the consumption of antibacterial agents in the reserve category also increased. The pattern of antimicrobial consumption in the hospital complex showed increased consumption in medical clinics and intensive care units, with a predominance of carbapenems, penicillins + beta-lactamase inhibitors, beta-lactamase-resistant penicillins, glycopeptides, fluoroquinolones, and polymyxin B, reflecting the care profile and influence of the COVID-19 pandemic.

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References

Afshinnekoo E, Bhattacharya C, Burguete-García A, Castro-Nallar E, Deng Y, Desnues C, et al. ECOVID-19 drug practices risk antimicrobial resistance evolution. Lancet Microbe. 2021;2(4):e135-e136.

Allel K, Peters A, Conejeros J, Martínez JRW, Spencer-Sandino M, Riquelme-Neira R, et al. Antibiotic consumption during the coronavirus disease 2019 pandemic and emergence of carbapenemase-producing klebsiella pneumoniae lineages among inpatients in a Chilean Hospital: a time-series study and phylogenomic analysis. Clin Infect Dis. 2023;77(Suppl 1): S20-S28.

Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655.

Antunes BBP, Silva AAB, Nunes PHC, Martin-Loeches I, Kurtz P, Hamacher S, et al. Antimicrobial consumption and drug utilization patterns among COVID-19 and non-COVID-19 patients. J Antimicrob Chemother. 2023;78(3):840-849.

ATC/DDD Index 2023. [cited 2023 Mar 16]. Available from : Available from : https://www.whocc.no/atc_ddd_index/

» https://www.whocc.no/atc_ddd_index/

Benkő R, Matuz M, Pető Z, Weist K, Heuer O, Vlahović-Palčevski V, et al. Members of the ESAC-Net AWaRe study group; ESAC-Net AWaRe study group. Trends in the hospital-sector consumption of the WHO AWaRe Reserve group antibiotics in EU/EEA countries and the United Kingdom, 2010 to 2018. 2022;27(41):2101058.

BRASIL. Conselho Nacional de Saúde. Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Brasília, DF: CNS, 2013. [cited 2023 Mar 16]. Available from: Available from: https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf

» https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf

Chi G, Memar Montazerin S, Lee JJ, Kazmi SHA, Shojaei F, Fitzgerald C, et al. Effect of azithromycin and hydroxychloroquine in patients hospitalized with COVID-19: Network meta-analysis of randomized controlled trials. J Med Virol. 2021;93(12):6737-6749.

Diallo OO, Barona SA, Colsona CAP, Chaudeta H, Rolain JM. Antibiotic resistance surveillance systems: A review. J Global Antimicrob Resist. 2020;23:430-438.

Grau S, Hernández S, Echeverría-Esnal D, Almendral A, Ferrer R, Limón E, et al. Catalan Infection Control and Antimicrobial Stewardship Program (VINCat-PROA). Antimicrobial Consumption among 66 Acute Care Hospitals in Catalonia: Impact of the COVID-19 Pandemic. Antibiotics (Basel). 2021;10(8):943.

Hodoșan V, Daina LG, Zaha DC, Cotrău P, Vladu A, Dorobanțu FR, et al. Pattern of antibiotic use among hospitalized patients at a level one multidisciplinary care hospital. Healthcare (Basel). 2023;11(9):1302.

Inoue M, Kohno S, Kaku M, Yamaguchi K, Igari J, Yamanaka K. PROTEKT 1999-2000: a multicenter study of the antimicrobial susceptibility of respiratory tract pathogens in Japan. Int J Infect Dis. 2005;9(1):27-36.

Jenkins SG, Brown SD, Farrell DJ. Trends in antibacterial resistance among Streptococcus pneumoniae isolated in the USA: update from PROTEKT US Years 1-4. Ann Clin Microbiol Antimicrob. 2008;7:1.

Langford BJ, So M, Raybardhan S, Leung V, Soucy JR, Westwood D, et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect 2021;27:520-31.

Martins MR, Bezerra VS, Oliveira FNM, Silva ARO, Lima EC. Drug and others products shortage in Brazilian health services in the scenario imposed by COVID-19. Research, Society and Development, [S. l.], 11(5), p. e26711527928, 2022. DOI: 10.33448/rsd-v11i5.27928. [cited 2023 Mar 16]. Available from: Available from: https://rsdjournal.org/index.php/rsd/article/view/27928

» https://doi.org/10.33448/rsd-v11i5.27928» https://rsdjournal.org/index.php/rsd/article/view/27928

Medeiros AF. Avaliação do uso de antimicrobianos e resistência microbiana: análise de séries temporais dos resultados de um programa de gerenciamento de antimicrobianos em um hospital público de ensino. [Dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais, Faculdade de Farmácia, Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica. 2022.

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.

Nadgir CA, Biswas DA. Antibiotic resistance and its impact on disease management. Cureus. 2023;15(4):e38251.

O’Neill J. Review on antimicrobial resistance: tackling drug-resistant infections globally: final report and recommendations. London, UK: Wellcome Trust, 2016:80.

Patel TS, McGovern OL, Mahon G, Osuka H, Boszczowski I, Munita JM, et al. Trends in inpatient antibiotic use among adults hospitalized during the coronavirus disease 2019 pandemic in Argentina, Brazil, and Chile, 2018-2021. Clin Infect Dis . 2023;77(Suppl 1):S4-S11.

Pauwels I, Versporten A, Drapier N, Vlieghe E, Goossens H, on behalf of the Global-PPS network. Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): results from a worldwide point prevalence survey in 69 countries. J Antimicrob Chemother . 2021;76:1614-1624.

Pereira ML, Mothé DA, Pinheiro KS, Gonçalves SS, Santos KV. Antibiotic dispensing during the first year of the COVID-19 pandemic in Brazilian public hospitals. Future Microbiol. 2023;18:639-647.

Porto APM, Goossens H, Versporten A, Costa SF; Brazilian Global-PPS Working Group. Global point prevalence survey of antimicrobial consumption in Brazilian hospitals. J Hosp Infect. 2020;104(2):165-171.

Rolain J-M, Abat C, Jimeno M-T, Fournier P-E, Raoult D. Do we need new antibiotics? Clin Microbiol Infect 2016;22:408-15.

Solanky D, McGovern OL, Edwards JR, Mahon G, Patel TS, Lessa FC, et al. Prescribing of outpatient antibiotics commonly used for respiratory infections among adults before and during the coronavirus disease 2019 pandemic in Brazil. Clin Infect Dis . 2023;77(Suppl 1):S12-S19.

Sulayyim HJA, Ismail R, Hamid AA, Ghafar NA. Antibiotic resistance during COVID-19: A systematic review. Int J Environ Res Public Health. 2022;19(19):1193.

Sulis G, Sayood S, Katukoori S, Bollam N, George I, Yaeger LH, et al. Exposure to World Health Organization’s AWaRe antibiotics and isolation of multidrug resistant bacteria: a systematic review and meta-analysis. Clin Microbiol Infect . 2022;28(9):1193-1202.

Teichert M, van der Aalst A, de Wit H, Stroo M, De Smet PA. How useful are prescribing indicators based on the DU90% method to distinguish the quality of prescribing between pharmacotherapy audit meetings with different levels of functioning? Eur J Clin Pharmacol. 2007;63(12):1171-7.

Thomas GR, Corso A, Pasterán F, Shal J, Sosa A, Pillonetto M, et al. Increased detection of carbapenemase-producing enterobacterales bacteria in Latin America and the Caribbean during the COVID-19 Pandemic. Emerg Infect Dis. 2022;28(11):1-8.

Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, et al. Global-PPS network. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health. 2018;(6):e619-e629.

WHO. The WHO AWaRE (Access, Watch, Reserve) antibiotic book. Geneva: World Health Organization; 2022.

Wushouer H, Zhou Y, Zhang W, Hu L, Du K, Yang Y, et al. Inpatient antibacterial use trends and patterns, China, 2013-2021. Bull World Health Organ. 2023;101(4):248-261B.

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2025-02-11

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Analysis of antibacterial agents consumption in a Brazilian southeastern hospital complex from 2018 to 2021. (2025). Brazilian Journal of Pharmaceutical Sciences, 61. https://doi.org/10.1590/