Is the Pendulum of Antimicrobial Drug Resistance Swinging Back after COVID-19?

Abstract

The COVID-19 pandemic may have had an effect on antimicrobial resistance. We compared the prevalence of ESKAPE multidrug-resistant (MDR) bacterial infections in COVID-19 affected/unaffected patients admitted to intensive care units (ICU) or infectious disease units at the “Mater Domini” University Hospital of Catanzaro between 1 March 2020 and 31 July 2021. Moreover, an analysis of MDR rates in ICU comparing the pre-pandemic period with the pandemic period was performed, and the possible consequence on in-hospital mortality was explored. One hundred and eighty-four ESKAPE isolates were analyzed from 362 SARS-CoV-2 positive and 199 negative patients. In total, 116 out of 171 Gram-negative isolates were classified as MDR, and a higher frequency was observed in COVID-19 compared with non-COVID-19 patients (74.2% vs. 60.3%; p = 0.052). A higher rate of MDR ESKAPE bacteria was observed in COVID-19 patients admitted to the ICU compared with COVID-19 unaffected patients admitted to the same ward in 2019 (88% vs. 80.4%; p = 0.186). Acinetobacter baumannii was the main pathogen in COVID-19 patients (58.7%), where it was the most frequent cause of bloodstream infection with the highest mortality rate (68.7%). Increase in MDR appeared to be associated with COVID-19 but only in the ICU setting. Acinetobacter baumannii was associated with the risk of death, indicating the importance of implementing infection control measures urgently.

Clinical Impact of COVID-19 on Multi-Drug-Resistant Gram-Negative Bacilli Bloodstream Infections in an Intensive Care Unit Setting: Two Pandemics Compared

“…We found that the overall MDR-GN BSI incidence density was lower in the CoV patients than the no-CoV ones, although the rate per pathogen showed an increase in the CRAB incidence in the former group of patients, albeit not significant. Several studies reported a decrease or no change in the incidence of MDRO colonization or infection in ICUs during the COVID-19 pandemic period, as with our findings [9,21,24,25], while other studies observed a significant increase in MDRO infections [15,20,22] or an increase only in a specific subgroup of patients with colonization or infection due to CRAB, as our study showed [9,21]. The change in our local epidemiology is associated with some outbreaks of CRAB infection during the observation period which reduced the K. pneumoniae incidence density.…”

“…Of interest, the burden of A. baumannii infections in CoV patients has been described worldwide with several outbreaks reported [ 19 ]. This so-called “little pandemic” within the huge COVID-19 pandemic represents a matter of concern as the greatest threat to COVID-19 patients admitted to ICUs [ 9 , 20 , 21 , 22 , 26 ]. However, new observational studies are needed to assess the real impact of CRAB invasive infections on mortality in critically ill CoV patients [ 20 , 22 , 26 ].…”

“…Among critically ill COVID-19 patients, BSIs are one of the major secondary infections often caused by Gram-negative bacteria [ 27 , 28 ]; moreover, several studies showed an increase in MDR-GN BSI during the COVID19 pandemic. Nevertheless, the real burden of these invasive infections and how they impact on mortality have not been fully estimated yet [ 14 , 20 , 22 , 26 ].…”

“…As a matter of fact, many hospitals have reported MDRO outbreaks in the ICU during the COVID-19 pandemic, mostly caused by Gram-negative bacteria or Candida auris [ 19 ]. Carbapenem-resistant Acinetobacter baumannii (CRAB) seems to be the main pathogen involved with a higher incidence compared to the pre-COVID-19 period and a higher risk of death than other MDROs [ 20 , 21 , 22 ].…”

Phascinating Phages

“…In recent decades, an increasing number of antibiotic-resistant bacterial strains have been reported. Therefore, conventional antibiotic therapy is often ineffective [ 1 , 2 , 3 ], leading to the search for new treatment options for bacterial infectious diseases. Several possibilities exist to overcome bacterial resistance to antibiotics; for example, the development of new effective antibiotics [ 4 ]; the testing of the antimicrobial effect of natural substances, such as herbal products [ 5 , 6 ], honey [ 7 ] or wine products [ 8 ]; the use of photodynamic inactivation [ 9 ] or the quorum-quenching approach [ 10 ]; or therapy that modulates the patient’s own immunity using immunomodulators of microbial origin or therapeutic autovaccines prepared from the patient’s own strains [ 11 ].…”