The impact of the COVID-19 pandemic on antimicrobial usage: an international patient-level cohort study

This multinational observational study analyzed patient-level data from nine countries to assess trends in antimicrobial prescriptions during the first 1.5 years of the COVID-19 pandemic. It focused on critically ill patients with pneumonia, ARDS, or sepsis, regardless of COVID-19 status. The study found significant increases in the use of broad-spectrum antibiotics such as meropenem (notably in Bangladesh and Turkey), moxifloxacin (Bangladesh), piperacillin/tazobactam (Italy), and azithromycin (Bangladesh and Brazil). Interrupted time series analyses showed changes over time, including a drop in azithromycin use in India and South Korea following updated WHO guidelines, and spikes in meropenem and moxifloxacin usage in Bangladesh, and sulfamethoxazole/trimethoprim in India after the Delta variant emerged. These findings underscore the pandemic’s impact on antimicrobial use and stress the importance of implementing strong antimicrobial stewardship programs, particularly during and between pandemics, to prevent overuse and resistance.