COVID-19 and the potential long-term impact on antimicrobial resistance

Abstract

The emergence of the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has required an unprecedented response to control the spread of the infection and protect the most vulnerable within society. Whilst the pandemic has focused society on the threat of emerging infections and hand hygiene, certain infection control and antimicrobial stewardship policies may have to be relaxed. It is unclear whether the unintended consequences of these changes will have a net-positive or -negative impact on rates of antimicrobial resistance. Whilst the urgent focus must be on controlling this pandemic, sustained efforts to address the longer-term global threat of antimicrobial resistance should not be overlooked.

The acquisition of Multi-drug resistant bacteria in patients admitted to COVID-19 intensive care units: a monocentric retrospective case control study

“…[23] The possibility of dissemination of MDRB during a viral pandemic had been theoretically mentioned [24], but as many previous pandemic occurred before the antimicrobial resistance era, no data was available before the SARS-CoV-2 pandemic, including the H1N1 pandemic. Experts have raised concern about the dissemination of MDRB during the COVID-19 pandemic [6,25,26] and a report indicates an increase in blood stream infection [27]. In line with these concerns, we observed a high rate of MDRB acquisition in COVID-19 patients at least as high as in non-COVID-19 patients.…”

“…Beside shortage of PPE [28] other factors suspected of causing a MDRB epidemic during COVID-19 are work overload of the ICU staff, ICU overcrowding, reinforcement of less experimented staff leading to a decreased in adherence to infection prevention and control measures. [6,25,26,29] Our study was not designed to decipher the respective role of these different mechanisms but we can venture some hypothesis to explain our ndings: due to the surge of patients, we had to adapt our usual single room policy creating a new 4-beds ICU with 2 occupants per room. However, staying in our 4-beds ICU was not associated with MDRB acquisition.…”

“…These factors can contribute to a decreased adherence to infection prevention and control measures and, combined with a high antimicrobial selection pressure, [5] may facilitate the emergence of antimicrobial resistance (AMR). [6] AMR is a major health problem, [7] responsible for high morbi-mortality [8,9] and an elevated economic burden. [10] The ICU is one of the hospital locations where patients have the highest risk of acquiring multi drug resistant bacteria (MDRB).…”

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

“…The literature on bacterial sputum cultures in COVID-19 report high rates of antibiotic use [28,29]. We observed this as well and demonstrated antimicrobial resistance development in over 10% of bacterial isolates late in patients' hospitalisations; this had been predicted [30] but also has been a topic of considerable debate [31,32,33,34].…”

A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

“…One concern among the infection prevention community is that the COVID-19 pandemic will cause “collateral damage” to long-established infection control measures including the prevention of healthcare-associated infections [ 8 ]. So far, it remains unknown if the present diversion of hospital resources and changes in infection control practices will translate into an increase of nosocomial transmissions, in particular of multidrug resistant organisms (MDRO), during the COVID-19 pandemic or if the increased efforts to improve infection control measures will have a positive effect on nosocomial MDRO transmissions [ 9 , 10 ].…”