Impact of COVID-19 on antimicrobial resistance: revealing the hidden threats
Keywords:COVID-19, Antimicrobial resistance, Stewardship, Antibiotics, Secondary bacterial infection
The COVID-19 pandemic, which was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has impacted every area of life, including efforts concerning antibiotic resistance (AMR). Antibiotic usage in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients exceeded the incidence of bacterial coinfections and secondary infections during the COVID-19 pandemic, suggesting irrational and excessive prescribing. Even in settings with established antimicrobial stewardship (AMS) programs, weaknesses were seen regarding the optimal use and administration of antibiotics during the epidemic. This irrational use and prescribing threaten the future of antimicrobial use and imply the possibility of another pandemic caused by multidrug-resistant pathogens.
In this review, we summarized the important aspects of COVID-19's impact, specifically on antimicrobials and other aspects. Antimicrobial stewardship programs are to be reinforced if not already implemented in all hospital settings to guide antimicrobial selection. This could contribute to combating this emerging concern of antimicrobial resistance.
Xiaobo Y, Yuan Y, Jiqian X, Huaqing S, Jia'an X, Hong L, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Med. 2020;8(5):475-81.
Rawson TM, Moore LSP, Zhu N. Bacterial and Fungal Coinfection in Individuals with Coronavirus: A Rapid Review to Support COVID-19 Antimicrobial Prescribing. Clin Infect Dis. 2020;71(9):2459-68.
Abelenda-Alonso G, Padullés A. Antibiotic prescription during the COVID-19 pandemic: A biphasic pattern. Infection control and hospital epidemiol. 2020;41(11):1371-2.
Bojana B, Doušak M. Antibiotic use in patients with COVID-19: a 'snapshot' Infectious Diseases International Research Initiative (ID-IRI) survey. J Antimicrobial Chemotherapy. 2020;75(11):3386-90.
Lynch C, Mahida N, Gray J. Antimicrobial stewardship: a COVID casualty? J Hospital Infection. 2020;106(3):401-3.
World Health Organization 10 Global Health Issues to Track in 2021. Available at: https://www.who.int/ news-room/spotlight/10-global-health-issues-to-track-in-2021. Accessed on 26 April 2022.
The World Bank Drug-Resistant Infections: A Threat to Our Economic Future. Available at: https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future. Accessed on 26 April 2022.
Anton PY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Eng J Med. 2010;362(19):1804-13.
Matthew NJ. Costs of healthcare- and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms. Clin Infect Dis. 2012;55(6):807-15.
Richard NE. National Estimates of Healthcare Costs Associated with Multidrug-Resistant Bacterial Infections Among Hospitalized Patients in the United States. Clin Infect Dis. 2021;72(1):S17-26.
European Centre for Disease Prevention and Control Antimicrobial resistance in the EU/EEA (EARS-Net)-Annual Epidemiological Report for 2019. Available at: https://www.ecdc.europa.eu/en/ publications-data/surveillance-antimicrobial-resistance-europe-2019. Accessed on 26 April 2022.
Steven SL, Oliver KB. Antibiotic resistance threats in the United States: stepping back from the brink. Am Family Physician. 2014;89(12):938-41.
Clancy CJ, Nguyen MH. Coronavirus Disease 2019, Superinfections, and Antimicrobial Development: What Can We Expect? Clin Infect Dis. 2020;71(10):2736-43.
European Centre for Disease Prevention and Control. "Surveillance of antimicrobial resistance in Europe–annual report of the European antimicrobial resistance surveillance network (EARS-Net) 2017." ECDC: Surveillance Report. 2018.
Velasco-Arnaiz E, López-Ramos MG, Simó-Nebot S. Kids Corona Project. Pediatric 205 antimicrobial stewardship in the COVID-19 outbreak. Infect Control Hosp Epidemiol. 2020;206:1-3.
Deanna JB. Antibiotic Consumption and Stewardship at a Hospital outside of an Early Coronavirus Disease 2019 Epicenter. Antimicrobial Agents Chemotherapy. 2020;64(11):e01011-20.
Matthew D. Using antibiotics responsibly: right drug, right time, right dose, right duration. J Antimicrobial Chemotherapy. 2011;66(11):2441-3.
Timothy RM. Antimicrobial use, drug-resistant infections and COVID-19. Nature reviews Microbiol. 2020;18(8):409-10.
Bengoechea JA, Bamford CG. SARS-CoV-2, bacterial co-infections, and AMR: the deadly trio in COVID-19? EMBO Mol Med. 2020;12(7):e12560.
Lansbury L, Lim B, Baskaran V. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020:S0163-4453(20)30323-6.
Rodríguez-Baño J, Rossolini GM, Schultsz C. Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance. Trans R Soc Trop Med Hyg. 2021;115(10):1122-9.
Langford BJ, So M, Raybardhan S. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26(12):1622-9.
Garcia-Vidal C, Sanjuan G, Moreno-García E. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2021;27(1):83-8.
Vaughn VM, Gandhi TN, Petty LA. Empiric Antibacterial Therapy and Community-onset Bacterial Coinfection in Patients Hospitalized with Coronavirus Disease 2019 (COVID-19): A Multi-hospital Cohort Study. Clin Infect Dis. 2021;72(10):e533-41.
Tedijanto C, Olesen SW, Grad YH, Lipsitch M. Estimating the proportion of bystander selection for antibiotic resistance among potentially pathogenic bacterial flora. Proc Natl Acad Sci USA. 2018;115(51):E11988-95.
Zakariya K. Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis. J Antimicrobial Chemotherapy. 2021;76(1):30-42.
WHO. Solidarity’ Clinical Trial for COVID-19 Treatments. Solidarity Clinical Trial for COVID-19 Treatments, www.who.int. 2021. Available online: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments. Accessed on 26 April, 2022.
Chanda-Kapata P, Kapata N, Zumla A. COVID-19 and malaria: A symptom screening challenge for malaria endemic countries. Int J Infect Dis. 2020;94:151-3.
Hiv L. When pandemics collide. The Lancet HIV. 2022;7(5):e301.
O'Brien KS, Emerson P, Hooper PJ. Antimicrobial resistance following mass azithromycin distribution for trachoma: a systematic review. Lancet Infect Dis. 2019;19(1):e14-25.
Dekker AR, Verheij TJ, van der Velden AW. Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients. Fam Pract. 2015;32(4):401-7.
Gulliford MC, Dregan A, Moore MV. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open. 2014;4(10):e006245.
Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect. 2020;26(10):1395-9.
Huttner BD, Catho G, Pano-Pardo JR, Pulcini C, Schouten J. COVID-19: don't neglect antimicrobial stewardship principles! Clin Microbiol Infect. 2020;26(7):808-10.
François B, Laterre PF, Luyt CE, Chastre J. The challenge of ventilator-associated pneumonia diagnosis in COVID-19 patients. Crit Care. 2020;24(1):289.
Fu Y, Yang Q, Xu M. Secondary Bacterial Infections in Critical Ill Patients with Coronavirus Disease 2019. Open Forum Infect Dis. 2020;7(6):ofaa220.
Losonczy LI, Barnes SL, Liu S. Critical care capacity in Haiti: A nationwide cross-sectional survey. PLoS One. 2019;14(6):e0218141.
Rosenthal VD, Belkebir S, Zand F. Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 246 intensive units of 83 hospitals in 52 cities of 14 countries of Middle East: Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates-International Nosocomial Infection Control Consortium (INICC) findings. J Infect Public Health. 2020;13(8):1134-41.
Phan HT, Vo TH, Tran HTT. Enhanced infection control interventions reduced catheter-related bloodstream infections in the neonatal department of Hung Vuong Hospital, Vietnam, 2011–2012: a pre- and post-intervention study. Antimicrob Resist Infect Control. 2020;9(9).
Aston SJ. Pneumonia in the developing world: Characteristic features and approach to management. Respirol. 2017;22:1276-87.
Schweitzer VA, Van Werkhoven CH, Rodríguez Baño J. Optimizing design of research to evaluate antibiotic stewardship interventions: consensus recommendations of a multinational working group. Clin Microbiol Infect. 2020;26(1):41-50.