It is complicated: Potential short- and long-term impact of coronavirus disease 2019 (COVID-19) on antimicrobial resistance—An expert review

Abstract

As of December 2021, the coronavirus disease 2019 (COVID-19) pandemic has claimed millions of deaths and caused disruptions in health systems around the world. The short- and long-term effects of COVID-19 on antimicrobial resistance (AMR), which was already a global threat before the pandemic, are manifold and complex. In this expert review, we summarize how COVID-19 might be affecting AMR in the short term (by influencing the key determinants antibiotic use, infection control practices and international/local mobility) and which additional factors might play a role in the long term. Whereas reduced outpatient antibiotic use in high-income countries, increased awareness for hand hygiene, and reduced mobility have likely mitigated the emergence and spread of AMR in the short term, factors such as overuse of antibiotics in COVID-19 patients, shortage of personal protective equipment, lack of qualified healthcare staff, and patient overcrowding have presumably facilitated its propagation. Unsurprisingly, international and national AMR surveillance data for 2020 show ambiguous trends. Although disruptions in antibiotic stewardship programs, AMR surveillance and research might promote the spread of AMR, other developments could prove beneficial to the cause in the long term. These factors include the increased public awareness for infectious diseases and infection control issues, the strengthening of the One Health perspective as outlined by the Centers for Disease Control and Prevention, and the unprecedented number of international research collaborations and platforms. These factors could even serve as leverage and provide opportunities to better combat AMR in the future.

Impacts of the COVID‐19 pandemic on antimicrobial use in companion animals in an academic veterinary hospital in North Carolina

“…Consequences of the pandemic on healthcare delivery are still being quantified. One area of uncertainty is how the pandemic affected AMU in companion animals and its potential downstream effects on AMR (CDC, 2022; Seneghini et al, 2022). At the NCSU‐CVM hospital, changes in AMU often varied by service; the internal medicine, dermatology, and surgery services used significantly more antimicrobials of higher importance during the pandemic, and cardiology used significantly fewer.…”

“…Since antimicrobial drugs exert selection pressure on bacterial populations, AMU may impact the prevalence and severity of AMR pathogens. Significant global health challenges such as the COVID‐19 pandemic can create opportunities for changes in AMU (CDC, 2022; Seneghini et al, 2022).…”

Antibiotic resistance and the COVID‐19 pandemic: A dual crisis with complex challenges in LMICs

“…In LMICs, the dearth of PPE has engendered unsafe medical practices, such as the sharing or reuse of PPE, thereby elevating the risk of cross‐transmission. This phenomenon is frequently implicated in the proliferation of multidrug‐resistant organism outbreaks 51 …”

Ten ways to make the most of World Antimicrobial Awareness Week

“…The increased awareness regarding the importance of infection prevention and control during the pandemic should also apply to AMR and may help garner research funding and public-sector support. 25…”