Abstract

Background This study aimed to evaluate the trends in antimicrobial prescription during the first 1.5 years of COVID-19 pandemic. Methods This was an observational, retrospective cohort study using patient-level data from Bangladesh, Brazil, India, Italy, Malawi, Nigeria, South Korea, Switzerland and Turkey from patients with pneumonia and/or acute respiratory distress syndrome and/or sepsis, regardless of COVID-19 positivity, who were admitted to critical care units or COVID-19 specialized wards. The changes of antimicrobial prescription between pre-pandemic and pandemic were estimated using logistic or linear regression. Pandemic effects on month-wise antimicrobial usage were evaluated using interrupted time series analyses (ITSAs). Results Antimicrobials for which prescriptions significantly increased during the pandemic were as follows: meropenem in Bangladesh (95% CI: 1.94–4.07) with increased prescribed daily dose (PDD) (95% CI: 1.17–1.58) and Turkey (95% CI: 1.09–1.58), moxifloxacin in Bangladesh (95% CI: 4.11–11.87) with increased days of therapy (DOT) (95% CI: 1.14–2.56), piperacillin/tazobactam in Italy (95% CI: 1.07–1.48) with increased DOT (95% CI: 1.01–1.25) and PDD (95% CI: 1.05–1.21) and azithromycin in Bangladesh (95% CI: 3.36–21.77) and Brazil (95% CI: 2.33–8.42). ITSA showed a significant drop in azithromycin usage in India (95% CI: −8.38 to −3.49 g/100 patients) and South Korea (95% CI: −2.83 to −1.89 g/100 patients) after WHO guidelines v1 release and increased meropenem usage (95% CI: 93.40–126.48 g/100 patients) and moxifloxacin (95% CI: 5.40–13.98 g/100 patients) in Bangladesh and sulfamethoxazole/trimethoprim in India (95% CI: 0.92–9.32 g/100 patients) following the Delta variant emergence. Conclusions This study reinforces the importance of developing antimicrobial stewardship in the clinical settings during inter-pandemic periods.