Comparison of antibiotic consumption and resistance in intensive care units in France before and during the COVID-19 pandemic.

Abstract

The COVID pandemic significantly impacted intensive care unit (ICU) antibiotic con sumption (AMC) and resistance (AMR). This study examines these effects over a 6-year period in 6 French ICUs.

Objectives: To evaluate the impact of the COVID pandemic on AMC and AMR in ICUs, focusing on changes in consumption patterns and bacterial resistance profiles.

Methods: Data were prospectively collected from 3 university hospitals, covering 6ICUs. The study compared two periods: before (2017-2019: befPAND period) and during (2020-2022: perPAND period) the pandemic. Antibiotic consumption was measured using Defined Daily Doses (DDD) globally per unit and per 1,000 patient-days in each unit. Antibiotic resistance was assessed from bacterial cultures from selected clinical cultures taken from ICU patients. Statistical analysis compared trends between the two periods.

Results: Total antibiotic consumption of all units increased by 28% during the pandemic period, but DDD/1000 patient-days of all units remained stable. There was an increase in the use of broad-spectrum antibiotics, particularly those classified as 'Reserve' by the WHO (5.6% to 9.6%, p < 0.0001).The number of positive cultures increased in the perPAND period for Staphylococcus epidermidis, Enterobacter sp., and Pseudomonas aeruginosa. Resistance levels showed an increase in Enterococcus species, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia, while methicillin-resistant Staphylococcus aureus and 3rd generation cephalosporins enterobacterales resistance remained stable.

Conclusions: The COVID pandemic increased the overall antibiotic consumption, but not the 1000-patients-day consumption in ICUs. However, one of the main effects was to shift usage towards more broad-spectrum antibiotics, which may contribute to growing resistance.