{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:43:55Z","timestamp":1783662235863,"version":"3.55.0"},"reference-count":43,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>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\u2019s 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\u20132022). 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.<\/jats:p>","DOI":"10.3390\/pathogens14111126","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T13:19:29Z","timestamp":1762348769000},"page":"1126","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond the Virus: The Collateral Impact of COVID-19 on Antimicrobial Consumption, Microbial Resistance, and Pharmacoeconomics"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4028-1152","authenticated-orcid":false,"given":"Alessandra Gomes","family":"Chauvin","sequence":"first","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6375-4640","authenticated-orcid":false,"given":"Isabele","family":"Pardo","sequence":"additional","affiliation":[{"name":"Faculdade Israelita de Ci\u00eancias da Sa\u00fade Albert Einstein, Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 Lu\u00eds F.","family":"Cotia","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella L.","family":"Rosmino","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana A.","family":"Marins","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandro Martins","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Barduchi","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra R.","family":"Toniolo","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta G.","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T.","family":"Malheiro","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anderson P.","family":"Scorsato","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elivane da Silva","family":"Victor","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4144-8974","authenticated-orcid":false,"given":"Michael B.","family":"Edmond","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506-9111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana Maria","family":"de Almeida","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7577-7688","authenticated-orcid":false,"given":"Alexandre R.","family":"Marra","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"},{"name":"Department of Internal Medicine, University of Iowa Health Care, Iowa City, IA 52242-1007, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"dlac130","DOI":"10.1093\/jacamr\/dlac130","article-title":"The Impact of COVID-19 on Multidrug-Resistant Organisms Causing Healthcare-Associated Infections: A Narrative Review","volume":"5","author":"Witt","year":"2022","journal-title":"JAC Antimicrob. 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