The impact of the COVID-19 pandemic on antimicrobial usage: an international patient-level cohort study.

Summary

Across nine countries, broad-spectrum antibiotic use often increased during the first 18 months of COVID-19 among patients with pneumonia/ARDS/sepsis, with policy- and variant-sensitive shifts. Azithromycin prescribing declined after WHO guidance in India and South Korea, while meropenem and others rose in specific settings, underscoring the need for resilient stewardship.

Key Findings

• Meropenem prescriptions rose during the pandemic in Bangladesh (OR 1.94–4.07; PDD 1.17–1.58) and Turkey (OR 1.09–1.58).
• Piperacillin/tazobactam increased in Italy (OR 1.07–1.48) with higher DOT (1.01–1.25) and PDD (1.05–1.21).
• Azithromycin increased in Bangladesh (OR 3.36–21.77) and Brazil (OR 2.33–8.42), then dropped in India and South Korea after WHO v1 guidance (e.g., −8.38 to −3.49 g/100 patients in India).
• ITS showed drug-specific surges aligned with the Delta variant (e.g., meropenem +93.40–126.48 g/100 patients in Bangladesh).

Clinical Implications

Hospitals should reinforce stewardship dashboards and rapid feedback, de-implement non-beneficial macrolide use, and monitor carbapenem and antipseudomonal beta-lactam consumption during respiratory infection surges.

Limitations

• Observational design with residual confounding and heterogeneity across sites.
• Microbiological confirmation and appropriateness of prescriptions not uniformly available.

Future Directions

Link prescribing patterns to patient outcomes and resistance trajectories; test targeted stewardship interventions during surge periods in ICU/COVID wards.