Alexandra Do Rosário Toniolo

Background: The COVID-19 pandemic had major global repercussions for hospitalized patients, affecting multiple aspects of hospital care. Understanding these effects is important for improving healthcare management and infection control practices. This study aimed to analyze and compare the pandemic’s impact on antimicrobial use in hospitalized patients, with emphasis on therapeutic, microbiological, and pharmacoeconomic aspects. Methods: A retrospective observational study was conducted at a Brazilian tertiary hospital (2018–2022). Adult patients receiving antimicrobials were included. Variables analyzed were antimicrobial consumption, incidence of healthcare-associated infections, resistance profiles, hospital costs, adverse drug reactions, and pharmacy activities. Data were obtained from anonymized institutional records and analyzed using descriptive statistics, time series, and linear regression. Results: Analysis of 268,713 hospitalizations showed that the median monthly number of patients receiving antimicrobials did not increase significantly during the pandemic. Higher consumption of carbapenems, glycopeptides, polymyxins, and echinocandins was linked to more healthcare-associated infections by multidrug-resistant organisms. Clostridioides difficile infections declined. Mortality rose significantly, especially among COVID-19 patients. Costs increased by 39%, with antimicrobial-related expenses up 45.7%. Conclusions: The pandemic intensified antimicrobial use, resistance, and costs. While limited by its single-center design and the use of all inpatients as the denominator, these findings highlight the important need for reinforced antimicrobial stewardship to build healthcare system resilience.

Background: The COVID-19 pandemic had major global repercussions for hospitalized patients, affecting multiple aspects of hospital care. Understanding these effects is important for improving healthcare management and infection control practices. This study aimed to analyze and compare the pandemic’s impact on antimicrobial use in hospitalized patients, with emphasis on therapeutic, microbiological, and pharmacoeconomic aspects. Methods: A retrospective observational study was conducted at a Brazilian tertiary hospital (2018–2022). Adult patients receiving antimicrobials were included. Variables analyzed were antimicrobial consumption, incidence of healthcare-associated infections, resistance profiles, hospital costs, adverse drug reactions, and pharmacy activities. Data were obtained from anonymized institutional records and analyzed using descriptive statistics, time series, and linear regression. Results: Among 268,713 hospitalizations, raw counts of hospitalizations and antimicrobial use were higher during the pandemic, though monthly averages showed no significant increase. Higher consumption of carbapenems, glycopeptides, polymyxins, and echinocandins was linked to more healthcare-associated infections by multidrug-resistant organisms. Clostridioides difficile infections declined. Mortality rose significantly, especially among COVID-19 patients. Costs increased by 39%, with antimicrobial-related expenses up 45.7%. Conclusions: The pandemic intensified antimicrobial use, resistance, and costs. Strengthening antimicrobial stewardship and infection control is essential to reduce future risks.

Klebsiella pneumoniae carbapenemase (KPC) actively hydrolyzes carbapenems, antibiotics often used a last-line treatment for multidrug-resistant bacteria. KPC clinical relevance resides in its widespread dissemination. In this work, we report the genomic context of KPC coding genes bla_KPC-2, bla_KPC-3 and bla_KPC-30 in multidrug-resistant Klebsiellapneumoniae isolates from Brazil. Plasmids harboring bla_KPC-3 and bla_KPC-30 were identified. Fifteen additional carbapenem-resistant K. pneumoniae isolates were selected from the same tertiary hospital, collected over a period of 8 years. Their genomes were sequenced in order to evaluate the prevalence and dissemination of bla_KPC–harboring plasmids. We found that bla_KPC genes were mostly carried by one of two isoforms of transposon Tn4401 (Tn4401a or Tn4401b) that were predominantly located on plasmids highly similar to the previously described plasmid pKPC_FCF3SP (IncN). The identified pKPC_FCF3SP-like plasmids carried either bla_KPC-2 or bla_KPC-30. Two K. pneumoniae isolates harbored pKpQIL-like (IncFII) plasmids, only recently identified in Brazil; one of them harbored bla_KPC-3 in a Tn4401a transposon. Underlining the risk of horizontal spread of KPC coding genes, this study reports the prevalence of bla_KPC-2 and the recent spread of bla_KPC-3, and bla_KPC-30, in association with different isoforms of Tn4401, together with high synteny of plasmid backbones among isolates studied here and in comparison with previous reports.