The impact of the COVID-19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

To evaluate the impact of the COVID-19 pandemic on the patterns of antimicrobial use and the incidence of pathogens in primary and secondary healthcare settings in Northern Ireland. Data was collected on antibiotic use and Gram-positive and Gram-negative pathogens from primary and secondary healthcare settings in Northern Ireland for the period before (January 2015-March 2020) and during the pandemic (April 2020-December 2021). Time-series intervention analysis methods were utilized. In the hospital setting, the mean total hospital antibiotic consumption during the pandemic was 1864.5 DDD per 1000 occupied bed days (OBD), showing no significant change from pre-pandemic (p=0.7365). During the pandemic: the use of second-generation cephalosporins, third generation cephalosporins, co-amoxiclav, and levofloxacin increased; there was a decrease in the percentage use of hospital Access group (p=0.0083) and an increase in the percentage use of Watch group (p=0.0040); and the number of hospital Klebsiella oxytoca and methicillin-susceptible Staphylococcus aureus cases increased. In primary care the mean total antibiotic consumption during the COVID-19 pandemic was 20.53 DDD per 1000 inhabitants per day (DID), compared to 25.56 DID before the COVID-19 pandemic (p= 0.0071). During the pandemic there was a decrease in use of several antibiotic classes, an increase in the percentage use of the Reserve group (p= 0.0032), and an increase in the number of community onset Pseudomonas aeruginosa cases. This study provides details of both changes in antibiotic consumption and the prevalence of infections in hospitals and primary care before and during the COVID-19 pandemic that emphasise the importance of antimicrobial stewardship in pandemic situations.