Paradigm Shift in Antimicrobial Resistance Pattern of Bacterial Isolates during the COVID-19 Pandemic

Abstract

Antimicrobial resistance (AMR) is an emerging public health problem in modern times and the current COVID-19 pandemic has further exaggerated this problem. Due to bacterial co-infection in COVID-19 cases, an irrational consumption of antibiotics has occurred during the pandemic. This study aimed to observe the COVID-19 patients hospitalized from 1 March 2019 to 31 December 2020 and to evaluate the AMR pattern of bacterial agents isolated. This was a single-center study comprising 494 bacterial isolates (blood and urine) that were obtained from patients with SARS-CoV-2 admitted to the ICU and investigated in the Department of Microbiology of a tertiary care hospital in Delhi, India. Out of the total bacterial isolates, 55.46% were gram negative and 44.53% were gram positive pathogens. Of the blood samples processed, the most common isolates were CoNS (Coagulase Negative Staphylococcus) and Staphylococcus aureus. Amongst the urinary isolates, most common pathogens were Escherichia coli and Staphylococcus aureus. A total of 60% MRSA was observed in urine and blood isolates. Up to 40% increase in AMR was observed amongst these isolates obtained during COVID-19 period compared to pre-COVID-19 times. The overuse of antibiotics gave abundant opportunity for the bacterial pathogens to gradually develop mechanisms and to acquire resistance. Since the dynamics of SARS-COV-2 are unpredictable, a compromise on hospital antibiotic policy may ultimately escalate the burden of drug resistant pathogens in hospitals. A shortage of trained staff during COVID-19 pandemic renders it impossible to maintain these records in places where the entire hospital staff is struggling to save lives. This study highlights the extensive rise in the use of antibiotics for respiratory illness due to COVID-19 compared to antibiotic use prior to COVID-19 in ICUs. The regular prescription audit followed by a constant surveillance of hospital infection control practices by the dedicated teams and training of clinicians can improve the quality of medications in the long run and help to fight the menace of AMR.

Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study

“…These rates (86.3%) are higher than a recent pilot study undertaken in India, with rates of 69.4% [ 63 ]. This is despite, as mentioned, only a limited number of patients with COVID-19 across ages having concomitant bacterial or fungal infections [ 17 , 18 , 19 , 20 , 21 , 22 , 31 , 66 ]. In addition, the Paediatric Association guidelines advocate only the prudent use of antibiotics due to concerns with potential over-use ( Table 1 ).…”

“…There are also increasing concerns with the inappropriate use of antimicrobials across LMICs. Patients with COVID-19 in hospitals are typically administered antibiotics despite only a limited number having concomitant bacterial or fungal infections [ 17 , 18 , 19 , 20 , 21 , 22 ]. This includes hospitals in Bangladesh [ 23 , 24 ].…”

The Impact of COVID-19 on the Profile of Hospital-Acquired Infections in Adult Intensive Care Units

“…During the pandemic, however, the sudden and enormous demands on healthcare systems has inevitably reduced the quality of infection control worldwide. Furthermore, the use of large amounts of antibiotics and immunosuppressive therapy in COVID-19 patients has only accentuated the problem of antimicrobial resistance (AMR) and the incidence of multidrug-resistant (MDR) organisms [8,9]. AMR is of particular concern in intensive care units (ICUs), where choices for empiric therapy are limited.…”

Comparing the Occurrence of Healthcare-Associated Infections in Patients with and without COVID-19 Hospitalized during the Pandemic: A 16-Month Retrospective Cohort Study in a Hospital Intensive Care Unit

“…Additionally, the clinical characteristics of COVID-19 patients, often requiring the use of invasive devices and a long ICU stay, could have contributed to the increase in HAIs [ 15 , 16 ]. Furthermore, the frequent use of antibiotics, especially in COVID-19 patients, might have accentuated antimicrobial resistance and the incidence of multidrug-resistant organisms in ICUs [ 17 ]. However, non-COVID-19 patients could also have been at high risk of HAI given their health conditions [ 18 ].…”