Related Experiment Video
Updated: Sep 28, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Reducing broad-spectrum antibiotic use in intensive care unit between first and second waves of COVID-19 did not
X H S Chan1, C J O'Connor2, E Martyn3
1Department of Clinical Microbiology, University College London NHS Foundation Trust, London, UK; Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Background:
The COVID-19 pandemic increased the use of broad-spectrum antibiotics due to diagnostic uncertainty, particularly in critical care. Multi-professional communication became more difficult, weakening stewardship activities.
Aim:
To determine changes in bacterial co-/secondary infections and antibiotics used in COVID-19 patients in critical care, and mortality rates, between the first and second waves.
Methods:
Prospective audit comparing bacterial co-/secondary infections and their treatment during the first two waves of the pandemic in a single-centre teaching hospital intensive care unit. Data on demographics, daily antibiotic use, clinical outcomes, and culture results in patients diagnosed with COVID-19 infection were collected over 11 months.
Findings:
From March 9th, 2020 to September 2nd, 2020 (Wave 1), there were 156 patients and between September 3rd, 2020 and February 1st, 2021 (Wave 2) there were 235 patients with COVID-19 infection admitted to intensive care. No significant difference was seen in mortality or positive blood culture rates between the two waves. The proportion of patients receiving antimicrobial therapy (93.0% vs 81.7%; P < 0.01) and the duration of meropenem use (median (interquartile range): 5 (2-7) vs 3 (2-5) days; P = 0.01) was lower in Wave 2. However, the number of patients with respiratory isolates of Pseudomonas aeruginosa (4/156 vs 21/235; P < 0.01) and bacteraemia from a respiratory source (3/156 vs 20/235; P < 0.01) increased in Wave 2, associated with an outbreak of infection. There was no significant difference between waves with respect to isolation of other pathogens.
Conclusion:
Reduced broad-spectrum antimicrobial use in the second wave of COVID-19 compared with the first wave was not associated with significant change in mortality.
Insights
Reduced broad-spectrum antibiotic use in critically ill COVID-19 patients during the second pandemic wave did not impact mortality rates. However, Pseudomonas aeruginosa infections increased, necessitating careful antimicrobial stewardship.
Area of Science:
- Critical care medicine
- Infectious diseases
- Epidemiology
Background:
- The COVID-19 pandemic led to increased broad-spectrum antibiotic use in critical care due to diagnostic uncertainty.
- Impaired multi-professional communication during the pandemic weakened antibiotic stewardship efforts.
Purpose of the Study:
- To compare bacterial co-/secondary infections and antibiotic usage in intensive care unit (ICU) patients with COVID-19 between the pandemic's first and second waves.
- To assess changes in mortality rates among these patients across the two waves.
Main Methods:
- A prospective audit was conducted in a single-centre teaching hospital's ICU over 11 months, covering the first two pandemic waves.
- Data collected included patient demographics, daily antibiotic use, clinical outcomes, and culture results for COVID-19 patients.
Main Results:
- While overall mortality and positive blood culture rates remained similar, the second wave saw a decrease in antimicrobial therapy (81.7% vs 93.0%) and meropenem duration.
- A significant increase in respiratory Pseudomonas aeruginosa isolates and bacteraemia occurred in the second wave, linked to an outbreak.
- No significant differences were observed in the isolation of other pathogens between the waves.
Conclusions:
- Reduced broad-spectrum antimicrobial use in the second COVID-19 wave was not associated with significant changes in patient mortality.
- The rise in Pseudomonas aeruginosa infections highlights the need for vigilant monitoring and targeted interventions within critical care settings.
More Related Videos
Related Concept Videos
01:28Antimicrobial Effectiveness
01:27Combined Effects of Drugs: Synergism
Such synergistic combinations...
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:28Acute Pyelonephritis II: Diagnostic Studies and Management