Danesh Moradigaravand, Abiola Senok, Laila Al-Dabal, Hamda Hassan Khansaheb, Maya Habous, Hanan Alsuwaidi, Alawi Alsheikh-Ali
Antimicrobial Resistance (AMR) presents a pressing public health challenge globally which has been compounded by the COVID-19 pandemic. Elucidation of the impact of the pandemic on AMR evolution using population-level data that integrates clinical, laboratory and prescription data remains lacking. Data was extracted from the centralized electronic platform which captures the health records of 60,551 patients with a confirmed infection across the network of public healthcare facilities in Dubai, United Arab Emirates. For all inpatients and outpatients diagnosed with bacterial infection between 01/01/2017 and 31/05/2022, structured and unstructured Electronic Health Record data, microbiological laboratory data including antibiogram, molecular typing and COVID-19 testing information as well as antibiotic prescribing data were extracted curated and linked.
Antimicrobial resistance (AMR) is a growing global public health threat driven by widespread and inappropriate use of antimicrobials. The limited pipeline of novel antimicrobials highlights the need for increased emphasis on preventive measures to curb the spread of resistance. To this end, understanding population-level trends in antimicrobial utilization and resistance is essential to inform targeted preventive interventions. More recently, the evolution of AMR has been compounded in part by the COVID-19 pandemic.
Materials and method
Data for 60,551 patients with confirmed bacterial infection was extracted from the centralized electronic platform for the Dubai Health Authority (DHA) which has now migrated to the newly created Dubai Academic Health Corporation. The dataset presented captures the patients seen in the public healthcare sector in Dubai during the study period. Based on publicly available data (2019–2021) reported in the Dubai Annual Health Statistics
The analysis of prescription and diagnostic laboratory data revealed that antimicrobials were prescribed at an average rate of 1.91 (with a minimum of 1.82 in 2022 and a maximum of 2.04 in 2020) and 1.30 (with a minimum of 1.28 in 2018 and a maximum of 1.32 in 2020) prescriptions per encounter for the inpatient and outpatient groups, respectively. A comparison of the most commonly prescribed antimicrobials showed a high degree of overlap between the inpatient and outpatient groups, with 67% (74 out of 110) of the antimicrobials being shared (S1A Fig). This finding is in line with a previous report of a comparable large-scale multi-center study in China, wherein the similarity in prescriptions between inpatient and outpatient groups was attributed to shared clinical practices and infection management .
Using a comprehensive set of large-scale clinical datasets, we analyzed the patterns of antimicrobial utilization and resistance in a large hospital network and assessed the effects of COVID-19 on these patterns. Our analysis of the comprehensive 5-year dataset (2017–2022) of clinical, diagnostic laboratory and prescription records revealed a significant and sudden shift in the use of antimicrobial drugs for both inpatient and outpatient populations, with some antimicrobials experiencing prolonged effects up to two years after the start of the COVID-19 pandemic. We also found a high mortality rate associated with infections caused by Gram-negative carbapenem resistant pathogens and a rapid impact of antimicrobial consumption on resistance patterns, observable within a few weeks.
We acknowledge the support of the Dubai Academic Health Corporation (DAHC) and Dubai Health Authority (DHA). The authors also acknowledge the kind support of the Information Technology Team (formerly of DHA and now DAHC); Dr Farida Alkhaja, Senior Advisor, DAHC, Dr Hussain Al Samt Head of Laboratories, DAHC; Dr Zulfa AlDeesi, Head of Clinical Microbiology Laboratory, Latifa Hospital, DAHC; Dr Mohamed Sameh Ali, Head of Pharmacy, Rashid Hospital, DAHC; and Dr Lina Bahjat, Senior Pharmacist, Rashid Hospital, DAHC.
Citation: Moradigaravand D, Senok A, Al-Dabal L, Khansaheb HH, Habous M, Alsuwaidi H, et al. (2023) Unveiling the dynamics of antimicrobial utilization and resistance in a large hospital network over five years: Insights from health record data analysis. PLOS Digit Health 2(12): e0000424. https://doi.org/10.1371/journal.pdig.0000424
Editor: Mengyu Wang, Harvard University, UNITED STATES
Received: June 26, 2023; Accepted: December 1, 2023; Published: December 29, 2023
Copyright: © 2023 Moradigaravand et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: We provide the code and aggregated data underlying the figures in the GitHub directory of the manuscript (https://github.com/DaneshMoradigaravand/DubaiAMRProject). The raw data includes patients' sensitive information and can be obtained by any user with sufficient justification through communication with the Dubai Scientific Research Ethics Committee at DSREC@dha.gov.ae.
Funding: This work was supported by the King Abdullah University of Science and Technology baseline grant (BAS/1/1108-01-01 to DM). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.