Impact of COVID-19 Towards Antibiotic Consumption in a Major Specialist Hospital: A Non-COVID-19 Hospital Perspective

Abstract

The Coronavirus disease 2019 (COVID-19) pandemic heavily affected healthcare services and medication supply. Literatures showed that the consumption of antibiotics was significantly increased during the pandemic especially in COVID-19 hospitals, however, little is known about the collateral impact of the pandemic in non-COVID-19 healthcare settings, such as Hospital Queen Elizabeth II (HQEII) based in Malaysia. This study aimed to compare the prevalence of antibiotic consumption before (2018 & 2019) and during (2020 & 2021) the pandemic, and to explore its impact on antibiotic-acquired cost and bacterial resistance. This is a descriptive observational study where the antibiotic consumption from 1st January 2018 to 31st December 2021 in HQEII was reviewed. The antibiotics selected were Meropenem, Vancomycin, Piperacillin-tazobactam, Ceftazidime and Ceftriaxone. The antibiotic consumption, antibiotic-acquired cost and cases of multidrug resistant organism (MRO) before (2018 & 2019) and during (2020 & 2021) the COVID-19 pandemic were compared, with combined 2 years data for comparison. The overall consumption of the selected antibiotics significantly increased by 45.2% (34.8 vs 50.5, p<0.001) during the COVID-19 pandemic. Intensive care unit had the highest increase in antibiotic consumption (+114.3%, p<0.001). There was a raising trend for the use of Vancomycin, Meropenem, Ceftazidime and Piperacillin-Tazobactam (p<0.005). All these contributed to a significant increase in antibiotic-acquired cost by 64.4% during the COVID-19 pandemic (RM909,898.80 vs RM1,486,791.20, p<0.001). Notably, cases of multidrug resistant organisms also increased, especially MRO Acinetobacter (+197%) and Carbapenem-resistant Enterobacterales (+92%). High antibiotic consumption, antibiotic-acquired cost and MRO cases were observed in non-COVID-19 healthcare setting during the pandemic, but the factors contributing to the surge were not explored in this study.