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Open Forum Infectious Diseases ; 9(Supplement 2):S756-S757, 2022.
Article in English | EMBASE | ID: covidwho-2189927


Background. During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities (HCFs) were overwhelmed with increasing patient volumes and limited resources. Reports of disruptions in routine practices at HCFs have emerged. We evaluated changes in policies, practices, and programs for antimicrobial stewardship (AMS), infection prevention and control (IPC), and clinical microbiology across six HCF in South America following the onset of the COVID-19 pandemic. Methods. We conducted a survey in 6 HCFs in Argentina, Brazil, and Chile;2 HCFs in each country. Data on 5 components (facility characteristics, antibiotic procurement and distribution, AMS activities, IPC activities, and clinical microbiology) were collected from designated specialists within each HCF from March 2018 - February 2021. We compared observations within these 5 components pre-pandemic (March 2018 - February 2020) to during pandemic (March 2020 - February 2021.) Results. During the pandemic, the number of ICU beds increased across all the 6 HCFs by 57-633%, and the number of ventilators increased by 15-317% in 5 out of the 6 HCFs. Healthcare personnel shortages were observed in all 6 HCFs, notably common for nurses and laboratory personnel (Table 1). Extended use of N95 respirators was reported across all 6 HCFs with 2 doing extended use of gowns and medical masks. The only PPE reused was N95 respirators in 2 HCFs. Difficulties in cohorting patients with multi-drug resistance organism (MDRO) was reported by one of the HCFs. Three HCFs reported shortages in drugs with coverage for MRSA, gramnegative bacteria, and fungal pathogens despite no reports of interruption in AMS activities in these HCFs. Two hospitals reported delays on microbiology results. Facility characteristics and reported changes during COVID-19 pandemic (March 2020-February 2021) Conclusion. The COVID-19 pandemic led to substantial increases in ICU beds, number of ventilators, and extended use of PPE suggesting increases in admission of severe patients and suboptimal IPC practices in HCFs in South America. It is unclear if shortages in agents commonly used to treat MDRO was related to overuse or access difficulties. Additional evaluation is needed to determine the impact of these findings on antimicrobial resistance and antimicrobial use.

Open Forum Infectious Diseases ; 9(Supplement 2):S59-S60, 2022.
Article in English | EMBASE | ID: covidwho-2189524


Background. Reports showing high rates of antibiotic use (AU) in patients with coronavirus disease 2019 (COVID-19) despite low rates of secondary bacterial infection have emerged from various countries across the globe. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in Argentina, Brazil, and Chile. Methods. We conducted an ecologic evaluation of AU in inpatient adult acute care wards (excluding maternity wards) in 6 HCFs in Argentina, Brazil, and Chile;2 HCFs per country. AU data for intravenously administered antibiotics commonly used to treat respiratory infections were collected from pharmacy dispensing records and aggregated to monthly defined daily dose (DDD)/1000 patient days. Graphs were created to depict AU and COVID-19 discharges over time throughout the 36-month study period (03/2018-02/2021). Relative changes in AU for all antibiotics combined and specific classes were calculated by comparing median AU for the 24-month prepandemic period (3/2018-2/2020) with the 12-month pandemic period (3/2020-2/ 2021). Only statistically significant differences (P< 0.05) determined by the Wilcoxon signed-rank test are reported. Results. Compared to the pre-pandemic period, the use of all included antibiotics combined increased in 4/6 HCFs (6.7-35.1%). In the 4 HCFs that experienced increases in AU, Figure 1 shows that use was high during months when COVID-19 patient surges occurred. In 3/4 of these HCFs, AU remained high despite significant decreases in COVID-19 discharges. Ceftriaxone use increased in 2/6 HCFs (27.1- 51.6%). Use of beta-lactam antibiotics with activity against Pseudomonas aeruginosa increased in 3/6 HCFs (31.3-82.5%) and decreased in 1/6 HCFs (-18.9%). Vancomycin and linezolid use increased in 3/6 HCFs (36.9-77.1%). Conclusion. Increases in AU among hospitalized adults were observed in 4 of 6 South American HCFs included in this study. The high rates of broad-spectrum antibiotic use in the HCFs may impact further emergence of antibiotic resistance. Understanding how this increase in antibiotic use compares to rates of bacterial infections during this time period is critical. (Figure Presented).

Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816902


Background: Patients with cancer, both active and previously treated, are at a higher risk of developing severe outcomes from COVID-19. During the pandemic, health care systems (HCS) have adapted the delivery of care, and disparities between private and public systems became even more striking. In Brazil, where 70% of the population depends on the public system, ICU demands largely exceed the capacity in most public centers, whereas in private centers the situation is less challenging. Herein we compare outcomes of patients with cancer and COVID-19 treated in the public and private HCS in Brazil. Methods: We used data from adult patients with solid malignancies who tested positive for COVID-19 and were admitted to two tertiary centers in the state of São Paulo. Patients who tested positive for SARS-CoV2 RNA real-time polymerase chain reaction (RT-PCR) were included. We collected data on baseline clinical conditions, cancer and treatment. Patients were classified by HCS: public system (public) versus (vs) private insurance coverage (private). The co-primary endpoints were all-cause mortality and a composite endpoint consisting of intensive-care-unit (ICU) admission, mechanical ventilation or death (ICU-MV-D). Chi-square, Fisher's exact test and Mann-Whitney U test were used when appropriate. We assessed the association between outcomes and HCS using logistic regression analyses, adjusting for age, sex, current anticancer treatment and comorbidities. Results: From March 16 to October 20 2020, 124 patients were identified. Of those, 90 (72%) were from the public and 34 (28%) from the private HCS. There were no statistical differences in sex, smoking, primary tumor siteand staging between patients from both HCS. Conversely, patients treated in the private system were older [66 (SD 13.8) vs 74 (SD 15.1), p=0.004], had more comorbidities (64.7% vs 37.8% p=0.009), and were on anticancer treatment more frequently (64.7% vs 34.4% p=0.004) compared to public patients. There were no differences in all-cause mortality (public 40% vs private 44.1% p=0.69) between patients treated at the different HCS. Nevertheless, in the composite outcome, private system was significantly associated with increased risk of ICU-MV-D compared to the public system (79.4% and 57.8% p=0.030, respectively). The median time from COVID-19 diagnosis to ICU-MV-D was 13 vs 8 days (p=0.031) and to death was 25 vs 24 days (p=0.24), respectively for public and private HCS patients. In the multivariable logistic regression, HCS was not associated with death [adjusted odds ratio (aOR)=1.16 p=0.75] or ICU-MV-D (aOR=0.55, p=0.27). Conclusion: While patients in the private system were older and had more comorbidities, there were no differences in inpatients all-cause mortality between private and public systems. However, private patients were associated with increased ICU-MV-D. We hypothesize that these findings may reflect disparities in ICU availability, known to be higher in the private system. Further studies investigating this hypothesis are warranted. EDR and DVA co-senior authors.