Could the COVID-19 pandemic aggravate antimicrobial resistance?

Rossato, Luana; Negrão, Fábio Juliano; Simionatto, Simone

doi:10.1016/j.ajic.2020.06.192

Cited by 39 publications

(41 citation statements)

References 6 publications

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“…Our results confirm that the implementation of antimicrobial stewardship programmes is a pivotal strategy to be urgently adopted in SARS-CoV-2 pandemic settings. 14 …”

Section: Discussionmentioning

confidence: 99%

Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

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Tiseo

Giordano

et al. 2020

Journal of Antimicrobial Chemotherapy

130

134

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Background Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19. Objectives To identify predictors of superinfections in COVID-19. Methods Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred ≥48 h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections. Results Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11–29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5–39.5, P < 0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4–13.1, P < 0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2–11.8, P < 0.001); C-reactive protein on admission >7 mg/dl (OR 3.59, 95% CI 1.7–7.7, P = 0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1–7.2, P = 0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11 days, P < 0.001), while mortality rates were similar (18.8% versus 23.2%, P = 0.445). Conclusions The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.

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“…Our results confirm that the implementation of antimicrobial stewardship programmes is a pivotal strategy to be urgently adopted in SARS-CoV-2 pandemic settings. 14 …”

Section: Discussionmentioning

confidence: 99%

Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

Falcone

Tiseo

Giordano

et al. 2020

Journal of Antimicrobial Chemotherapy

130

134

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“…The abuse of antimicrobials in acute care settings can stimulate the development of MDR strains [ 7 , 11 , 12 , 13 ]. In this sense, a retrospective observational study analysed the bimonthly incidence of carbapenem-resistant Enterobacteriaceae (CRE) colonisation and the incidence of CRE acquisition in an Italian intensive care unit from January 2019 to June 2020 and reported that the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March–April 2020.…”

Section: Discussionmentioning

confidence: 99%

“…To deduce whether these changes were due to COVID-19, we compared the detailed consumption information for the COVID-19 ward and the hospital without the COVID-19 ward. During the pandemic period (weeks [10][11][12][13][14][15][16][17][18][19][20], no difference was shown regarding antimicrobial prescription (700.3 ± 354.8 vs. 781.8 ± 104.0 DDD per 1000 OBD; p = 0.479), even though the antimicrobial use for weeks 16-20 was significantly higher in the COVID-19 ward (Table 1).…”

Section: Antimicrobial Consumptionmentioning

confidence: 95%

“…Recent studies have reported an unjustified increase of antimicrobial use during the COVID-19 pandemic [ 8 ], despite recommendations against it unless bacterial or fungal coinfections were demonstrated [ 9 , 10 ]. The impact of the overuse of these therapies on the propagation of antimicrobial resistance could be an indirect adverse consequence of the pandemic [ 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections

et al. 2020

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During the COVID-19 pandemic, the implementation of antimicrobial stewardship strategies has been recommended. This study aimed to assess the impact of the COVID-19 pandemic in a tertiary care Spanish hospital with an active ongoing antimicrobial stewardship programme (ASP). For a 20-week period, we weekly assessed antimicrobial consumption, incidence density, and crude death rate per 1000 occupied bed days of candidemia and multidrug-resistant (MDR) bacterial bloodstream infections (BSI). We conducted a segmented regression analysis of time series. Antimicrobial consumption increased +3.5% per week (p = 0.016) for six weeks after the national lockdown, followed by a sustained weekly reduction of −6.4% (p = 0.001). The global trend for the whole period was stable. The frequency of empirical treatment of patients with COVID-19 was 33.7%. No change in the global trend of incidence of hospital-acquired candidemia and MDR bacterial BSI was observed (+0.5% weekly; p = 0.816), nor differences in 14 and 30-day crude death rates (p = 0.653 and p = 0.732, respectively). Our work provides quantitative data about the pandemic effect on antimicrobial consumption and clinical outcomes in a centre with an active ongoing institutional and education-based ASP. However, assessing the long-term impact of the COVID-19 pandemic on antimicrobial resistance is required.

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“…The prevalence of telemedicine to control antimicrobial stewardship has previously demonstrated an improved selection of antibiotics and decline in resistance [ 84 ]. It is important to collect microbiological data, primarily to classify formerly identified or evolving pathogens linked to secondary co-infections in patients with SARS [ 85 ]. Epidemiological investigations with AMR surveillance systems that endorse the generation of the standard datasets on the efficacy of antimicrobial intercession in COVID-19 patients, particularly in acute stage patients in ICUs, should be sustained [ 86 ].…”

Section: Tackling Measuresmentioning

confidence: 99%

Coalescence of co-infection and antimicrobial resistance with SARS-CoV-2 infection: The blues of post-COVID-19 world

Mazumder

Kalamdhad

Chaminda

et al. 2021

Case Studies in Chemical and Environmental Engineering

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In viral respiratory infections, bacterial co-pathogens are widely known to co-infect, and they significantly increase the morbidity and mortality rate. During the influenza season, the advent of 2019-nCoV (novel coronavirus) has led to the widespread use of oral and intravenous antibiotics and inhibitors of neuraminidase enzyme. Owing to causes such as extended intubation, the ubiquitous use of intrusive catheters, and compromised host immunity, coronavirus disease (COVID-19) patients are at heightened risk of secondary bacterial and fungal infections, leading to the difficulty in their treatment. Apart from the pandemic, the primary risk is a likely surge in multidrug resistance. In this work, we evaluated the coalescence of present co-infection alongside the COVID-19 and post-pandemic antimicrobial resistance due to high ongoing drug use for the treatment of COVID-19. We found that while there is currently limited evidence of bacterial infections in COVID-19, available proof supports the restricted use of antibiotics from an antibiotic stewardship viewpoint, primarily upon entry. Paramount attempts should be made to collect sputum and blood culture samples as well as pneumococcal urinary antigen monitoring in order to endorse stringent antibiotic usage. For antimicrobial stewardship, inflammatory markers like procalcitonin have been added, but such biomarkers are typically upraised in COVID-19. Antimicrobials cannot be completely removed in wastewater treatment plants (WWTPs) and once they enter the water environment, possesses great risk of inducing resistance to drugs in microbes. Hence, their prescription and administrations should be regulated and alternate solutions such as vaccines, preventive measures and personal hygiene should be given top priority. It is imperative to establish an antimicrobial strategy discrete to COVID-19, as this pandemic has caused outbreak of numerous other associated diseases and has the potential to drive microbial resistance. Coordinated plans are essential for this at the citizen, health-care and policy levels.

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Could the COVID-19 pandemic aggravate antimicrobial resistance?

Abstract: Protective adaptive immunity against severe acute respiratory syndrome coronaviruses 2 (SARS-CoV-2) and implications for vaccines. Cureus. 2020;12:e8399.

Cited by 39 publications

References 6 publications

Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections

Coalescence of co-infection and antimicrobial resistance with SARS-CoV-2 infection: The blues of post-COVID-19 world

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