Abstract：
BACKGROUND: There was a reported increase in the antimicrobial consumption in hospitals during the COVID-19 pandemic, accompanied by an increase in infections due to multidrug-resistant (MDR) bacteria.
METHODS: This retrospective time series study from intensive care units in Buenos Aires examined changes in antibiotic consumption (defined daily doses/1000 patients/day), the incidence of Gram-negative bacilli (GNB) and the mechanism of resistance. Antibiotics were categorised into group 1 (agents against MDR GNB) and group 2 (agents against non-MDR infections). Bacteriological samples included respiratory samples and blood cultures. Periods were divided into pre-pandemic (July 2019 to March 2020) and pandemic (April 2020 to March 2022). Correlation coefficients (r) were analysed and the Mann-Whitney test was performed to compare both periods.
RESULTS: During the study period, GNB incidence, group 1 antibiotic consumption and resistance mechanisms increased, whereas antibiotics decreased in group 2. A significant positive correlation was seen between the consumption of antibiotics in group 1 and the incidence of GNB (r = 0.63; P < 0.001) and resistance (r = 0.52; P = 0.002). Significant differences were found between pre-pandemic and pandemic periods regarding the medians of group 1 consumption (520 [408-570] vs. 753 [495-851] DDD/1000 patients/day; P = 0.029), incidence of GNB (12 [10-13] vs. 43 [25-52.5] cases/month; P < 0.001) and resistance mechanisms (5 [4-8] vs. 17 [10-25] cases/month; P < 0.001), extended-spectrum beta lactamases (2 [1-2] vs. 6 [3-8] cases/month; P < 0.001) and metallo-beta-lactamases (0 [0-0] vs. 6 [1.75-8.5] cases/month; P < 0.001).
CONCLUSIONS: During the COVID-19 pandemic, the rise in GNB incidence and the amount of resistance mechanisms significantly correlated with the increase in consumption of agents against MDR strains.
METHODS: This retrospective time series study from intensive care units in Buenos Aires examined changes in antibiotic consumption (defined daily doses/1000 patients/day), the incidence of Gram-negative bacilli (GNB) and the mechanism of resistance. Antibiotics were categorised into group 1 (agents against MDR GNB) and group 2 (agents against non-MDR infections). Bacteriological samples included respiratory samples and blood cultures. Periods were divided into pre-pandemic (July 2019 to March 2020) and pandemic (April 2020 to March 2022). Correlation coefficients (r) were analysed and the Mann-Whitney test was performed to compare both periods.
RESULTS: During the study period, GNB incidence, group 1 antibiotic consumption and resistance mechanisms increased, whereas antibiotics decreased in group 2. A significant positive correlation was seen between the consumption of antibiotics in group 1 and the incidence of GNB (r = 0.63; P < 0.001) and resistance (r = 0.52; P = 0.002). Significant differences were found between pre-pandemic and pandemic periods regarding the medians of group 1 consumption (520 [408-570] vs. 753 [495-851] DDD/1000 patients/day; P = 0.029), incidence of GNB (12 [10-13] vs. 43 [25-52.5] cases/month; P < 0.001) and resistance mechanisms (5 [4-8] vs. 17 [10-25] cases/month; P < 0.001), extended-spectrum beta lactamases (2 [1-2] vs. 6 [3-8] cases/month; P < 0.001) and metallo-beta-lactamases (0 [0-0] vs. 6 [1.75-8.5] cases/month; P < 0.001).
CONCLUSIONS: During the COVID-19 pandemic, the rise in GNB incidence and the amount of resistance mechanisms significantly correlated with the increase in consumption of agents against MDR strains.
摘要：
在COVID-19大流行期间，医院的抗菌药物消费量增加，据报道，由于多药耐药（MDR）细菌引起的感染增加。
方法：来自重症监护病房的回顾性时间序列研究，为了解决抗生素消费的变化（DDD/1000名患者/天），革兰阴性杆菌（GNB）的发生率和耐药机制。抗生素分为第1组（针对多药耐药MDRGNB的药物）和第2组（针对非MDR感染的药物）。细菌学样品包括呼吸道样品和血液培养物。时期分为大流行前（2019年7月至2020年3月）和大流行（2020年4月至2022年3月）。分析相关系数（r），并进行Mann-Whitney检验以比较两个时期。
结果：在研究期间，GNB发病率,第一组抗生素消耗和耐药机制增加，而第2组抗生素减少。在第1组中，抗生素的消耗量与GNB的发生率（r=0,63；p<0.001）和耐药性（r=0,52；p=0.002）之间存在显着正相关。大流行前和大流行期之间的第1组消费中位数存在显着差异（520[408-570]vs753[495-851]DDD/1000患者/天；p=0.029）；GNB的发生率（12[10-13]vs43[25-52.5]例/月；p<0.001）和耐药机制（5[4-8]vs17[10-25]例/月；0.001，pESBL(2[1-2]vs6[3-8]例/月;p<0.001)和MBL(0[0-0]vs6[1.75-8.5]例/月;p<0.001)。
结论：在大流行期间，GNB发病率和抗性机制数量的增加与抗MDR菌株药物消耗量的增加显著相关。
方法：来自重症监护病房的回顾性时间序列研究，为了解决抗生素消费的变化（DDD/1000名患者/天），革兰阴性杆菌（GNB）的发生率和耐药机制。抗生素分为第1组（针对多药耐药MDRGNB的药物）和第2组（针对非MDR感染的药物）。细菌学样品包括呼吸道样品和血液培养物。时期分为大流行前（2019年7月至2020年3月）和大流行（2020年4月至2022年3月）。分析相关系数（r），并进行Mann-Whitney检验以比较两个时期。
结果：在研究期间，GNB发病率,第一组抗生素消耗和耐药机制增加，而第2组抗生素减少。在第1组中，抗生素的消耗量与GNB的发生率（r=0,63；p<0.001）和耐药性（r=0,52；p=0.002）之间存在显着正相关。大流行前和大流行期之间的第1组消费中位数存在显着差异（520[408-570]vs753[495-851]DDD/1000患者/天；p=0.029）；GNB的发生率（12[10-13]vs43[25-52.5]例/月；p<0.001）和耐药机制（5[4-8]vs17[10-25]例/月；0.001，pESBL(2[1-2]vs6[3-8]例/月;p<0.001)和MBL(0[0-0]vs6[1.75-8.5]例/月;p<0.001)。
结论：在大流行期间，GNB发病率和抗性机制数量的增加与抗MDR菌株药物消耗量的增加显著相关。
