Birgitta Schweickert (Berlin / DE), Marcel Feig (Berlin / DE), Marc Schneider (Berlin / DE), Michael Behnke (Belin / DE), Luis Alberto Peña Diaz (Belin / DE), Christine Geffers (Belin / DE), Karin Gröschner (Berlin / DE), Doreen Richter (Berlin / DE), Tim Eckmanns (Berlin / DE), Muna Abu-Sin (Berlin / DE)
Background: The SARS-CoV-2-pandemic has affected the framework conditions in which hospital antimicrobial prescribing occurred.
Goals: Data on the development of the consumption of reserve-antibiotics in the hospital sector from 2018 to 2022 are presented.
Materials and Methods: Data from 180 hospitals, continuously participating from 2018 to 2022 in the national surveillance system of hospital antimicrobial consumption (AMC, Robert Koch Institute), were analyzed according to the ATC (Anatomical Therapeutic Chemical)/DDD (Defined Daily Dose)-method of WHO. AMC was quantified by consumption density (CD) expressed in DDD/100 patient days (PD) and DDD/100 admissions (AD). Data on antibiotics belonging to the reserve-group according to the AWaRe-classification of WHO have been analyzed for the whole hospital and stratified by ward type (intensive care unit (ICU), general ward).
Results: From 2018 to 2022 the CDs of reserve-antibiotics increased from 1.3 to 1.8 DDD/100 PD by 42% and accounted for 2.4% and 3.4% of total consumption in 2018 and 2022, respectively (Table 1). The strongest increase occurred in 2020 and 2021 and slowed down in 2022. Stratification by ward type revealed that on ICUs the CDs showed the steepest increase in 2021 followed by a decrease in 2022. On general wards the CDs presented with a linear increase from 2018 to 2021 that slowed down in 2022. Except for polymyxines i.v and tigecycline, a rise of varying degrees could be observed for linezolid, daptomycin, fosfomycin i.v., ceftazidim/avibactam, cefiderocol and aztreonam. The most prominent increases could be observed in antibiotics assumed to be effective against carbapenem-resistant gram-negative pathogens. On ICUs, CDs expressed in DDD/100 AD showed relatively higher increases during the two pandemic years compared to those expressed in DDD/100 PD, which went along with a rise of the length of stay.
Summary: The rise of most reserve-antibiotics showed the strongest increase during the pandemic years 2020 and 2021 and no return to pre-pandemic values in 2022. Close monitoring of these agents and assurance of their prudent use constitute important targets of antibiotic stewardship activities.