Antimicrobial Resistance Threats in the emerging COVID-19 pandemic: Where do we stand?

Ghosh, Soumya; Bornman, Charné; Zafer, Mai M.

doi:10.1016/j.jiph.2021.02.011

Cited by 138 publications

(139 citation statements)

References 52 publications

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“…High empiric use of broad-spectrum antibiotics observed for COVID-19 patients is heightening concern that antibiotic overuse during the COVID-19 pandemic will exacerbate the problem of antimicrobial resistance in microorganisms of clinical significance into the future. ( 36 , 37 , 38 ) The review by Rawson et al found that 72% of COVID-19 patients had received antibacterial therapy and that recorded agents tended to be broad-spectrum antibiotics prescribed empirically in both critical and non-critical settings. ( 10 ) A meta-analysis by Langford and colleagues of 3,338 hospitalised and critical COVID-19 patients across 24 studies reported that a majority of COVID-19 patients received antibiotics (71.9%, 95% confidence interval (CI): 56.1-87.7%).…”

Section: Multi-drug Resistance and Antimicrobial Stewardshipmentioning

confidence: 99%

The interface between COVID-19 and bacterial healthcare-associated infections

O'Toole

2021

Clinical Microbiology and Infection

121

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Background A wide range of bacterial infections occur in COVID-19 patients, particularly, in those with severe coronaviral disease. Some of these are community acquired co-infections. Objective To review recent data which indicate the occurrence of hospital-onset bacterial infections, including with antibiotic-resistant isolates, in COVID-19 patients. Sources Using PubMed, the literature was searched using terms including: “COVID-19”; “SARS-CoV-2”; “bacterial infection”; “healthcare-associated infection”; “antibiotic resistance”; “antimicrobial resistance”; “multi-drug resistance”; “ Streptococcus ”; “ Staphylococcus ”; “ Pseudomonas ”; “ Escherichia ”; “ Klebsiella ”; “ Enterococcus ”; “ Acinetobacter ”; “ Haemophilus ”; “MRSA”; “VRE”; “ESBL”; “NDM-CRE”; “CR-Ab”; “VRSA”; “MDR”. Content There is a growing number of reports of bacterial infections acquired by patients with severe COVID-19 after hospital admission. Antibiotic-resistant pathogens found to cause healthcare-associated infections (HAIs) in COVID-19 patients include Methicillin-Resistant Staphylococcus aureus (MRSA), New Delhi Metallo-β-lactamase-producing Carbapenem-Resistant Enterobacterales (NDM-CRE), Carbapenem-Resistant Acinetobacter baumannii (CR-Ab), Extended-Spectrum β-Lactamase (ESBL) Klebsiella pneumoniae , and Vancomycin-Resistant Enterococci (VRE). COVID-19 has impacted bacterial HAIs in a number of ways with an increase in the incidence of NDM-CRE and CR-Ab reported at some hospital sites compared to before the pandemic. Recommended guidelines for antimicrobial stewardship in COVID-19 patient treatment are discussed regarding minimisation of empiric broad-spectrum antibiotic use. Other studies have reported a decrease in MRSA and VRE cases that has been attributed to enhanced infection prevention and control (IPC) practices introduced to minimise intra-hospital spread of COVID-19. Implications Poorer outcomes have been observed in hospitalised COVID-19 patients with an antibiotic-resistant infection. While heightened IPC measures have been accompanied by a reduction in some HAIs at specific sites, in other situations, COVID-19 has been associated with an increase in bacterial HAI incidence. Further research is needed to define the cost-benefit relationship of maintaining COVID-19-related IPC protocols beyond the pandemic to reduce the burden of HAIs. In addition, the longer-term impact of high usage of certain broad-spectrum antibiotics during the COVID-19 pandemic requires evaluation.

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Section: Multi-drug Resistance and Antimicrobial Stewardshipmentioning

confidence: 99%

The interface between COVID-19 and bacterial healthcare-associated infections

O'Toole

2021

Clinical Microbiology and Infection

121

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“…Fourthly, data on empirical and targeted antimicrobial therapy were not collected in all patients but only in patients with BSI. Data on the use of antibiotics in COVID-19 patients suggest an excessive use of antimicrobial agents [ 3 , 4 ] that may exceed the incidence of proven bacterial infections as recently described by Cultrera et al [ 12 ] and may have an impact on the future circulation of MDR pathogens [ 22 , 23 , 24 ]. Therefore, further studies are needed in this direction in order to promote antimicrobial stewardship principles, as suggested by Huttner et al in a recent review [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors and Impact on Clinical Outcomes of Bloodstream Infections in Patients Hospitalised with COVID-19: A Prospective Cohort Study

et al. 2021

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With the aim of describing the burden and epidemiology of community-acquired/healthcare-associated and hospital-acquired bloodstream infections (CA/HCA-BSIs and HA-BSIs) in patients hospitalised with COVID-19, and evaluating the risk factors for BSIs and their relative impact on mortality, an observational cohort study was performed on patients hospitalised with COVID-19 at San Paolo Hospital in Milan, Italy from 24 February to 30 November 2020. Among 1351 consecutive patients hospitalised with COVID-19, 18 (1.3%) had CA/HCA-BSI and 51 (3.8%) HA-BSI for a total of 82 episodes of BSI. The overall incidence of HA-BSI was 3.3/1000 patient-days (95% CI 2.4–4.2). Patients with HA-BSI had a longer hospital stay compared to CA/HCA-BSI and no-BSI groups (27 (IQR 21–35) vs. 12 (7–29) vs. 9 (5–17) median-days, p < 0.001) but a similar in-hospital mortality (31% vs. 33% vs. 25%, p = 0.421). BSI was not associated with an increased risk of mortality (CA/HCA-BSI vs. non-BSI aOR 1.27 95% CI 0.41–3.90, p = 0.681; HA-BSI vs. non-BSI aOR 1.29 95% CI 0.65–2.54, p = 0.463). Upon multivariate analysis, NIMV/CPAP (aOR 2.09, 95% CI 1.06–4.12, p = 0.034), IMV (aOR 5.13, 95% CI 2.08–12.65, p < 0.001) and corticosteroid treatment (aOR 2.11, 95% CI 1.06–4.19, p = 0.032) were confirmed as independent factors associated with HA-BSI. Development of HA-BSI did not significantly affect mortality. Patients treated with corticosteroid therapy had double the risk of developing BSI.

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“…All the above findings indicated that the inappropriate use of antibiotic during COVID-19 pandemic is obvious [ 17 ]. Because antibiotic overuse can result in the increasing consumption of antibiotics and cause the collateral damage – increasing antimicrobial resistance [ 18 , 19 ], how to avoid the inappropriate use of antimicrobial agents has become another great challenge. Continuing implementation of antibiotic stewardship program in optimizing the antimicrobial therapy among hospitalized COVID-19 patients could be a possible solution.…”

Section: Antibiotic Overusementioning

confidence: 99%

Appropriate use of Antimicrobial Therapy For COVID-19 Co-Infection

Lai

2021

Immunotherapy

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Antimicrobial Resistance Threats in the emerging COVID-19 pandemic: Where do we stand?

Cited by 138 publications

References 52 publications

The interface between COVID-19 and bacterial healthcare-associated infections

The interface between COVID-19 and bacterial healthcare-associated infections

Incidence, Risk Factors and Impact on Clinical Outcomes of Bloodstream Infections in Patients Hospitalised with COVID-19: A Prospective Cohort Study

Appropriate use of Antimicrobial Therapy For COVID-19 Co-Infection

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