Potential impact of COVID-19 on the consumption profile of reserve antibacterials - AWaRe in an intensive care unit of a public hospital

Abstract

Objective: To evaluate the variation in consumption of antibacterials (ATB), listed by the National Health Surveillance Agency, components of the reserve group according to the Access, Watch, Reserve (AWaRe) classification of the World Health Organization (WHO), in an Intensive Care Unit (ICU) of a public hospital. Method: This is a quantitative drug utilization study, with retrospective data collection from November/2018 to October/2022. As recommended by the WHO Study Group on Drug Utilization, the Daily Defined Dose (DDD) per 1000 patient-days was used to evaluate the consumption of daptomycin, parenteral linezolid, polymyxin B and E, tigecycline and ceftazidime-avibactam. The DDD were calculated using the WHO standard DDD formula. The analysis period was divided into three phases: pre-pandemic of the COVID-19, acute phase and post-acute phase of the COVID-19 pandemic. The sum of monthly DDD was compared between the three phases. Results: In the ICU of the study hospital, there was an increased consumption of daptomycin and tigecycline during the acute phase, and of all the six ATB during the post-acute phase in comparison to the pre-pandemic period. During the postacute phase, the consumption of daptomycin, linezolid and polymyxin B was higher than the acute phase. The consumption of polymyxin B, polymyxin E and tigecycline was influenced by market instability. The institutional formulary was changed from the acute phase of the pandemic with incorporation of polymyxin E and ceftazidime-avibactam. Conclusion: This study identified variations in the consumption of ATB in the reserve group, which may have been influenced by the COVID-19 pandemic. These data can promote the basis for improvements in local ASP to preserve the effectiveness of these drugs, which should be used as the last therapeutic alternative.