PRO: The COVID-19 pandemic will result in increased antimicrobial resistance rates

Abstract

We argue that the COVID-19 pandemic will result in increased antimicrobial resistance (AMR). Broad-spectrum antibiotic use is common among hospitalized COVID-19 patients and in excess of reported secondary infection rates, suggesting unnecessary prescribing. Selection pressure is likely to be particularly intense in COVID-19 epicentres and within non-epicentre hospital units dedicated to COVID-19 care. Risk factors that increase the likelihood of hospitalization or poor outcomes among COVID-19 patients, such as advanced age, nursing home residence, debilitation, diabetes and cardiopulmonary or other underlying systemic diseases, also predispose to AMR infections. Worry for AMR emergence is heightened since first-wave COVID-19 epicentres were also AMR epicentres. Disruptive direct and indirect effects of COVID-19 globally on economic systems, governance and public health expenditure and infrastructure may fuel AMR spread. We anticipate that the impact of COVID-19 on AMR will vary between epicentres and non-epicentres, by geographic region, hospital to hospital within regions and within specific hospital units.

Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis

“…Pandemic-associated changes in human behaviour and healthcare practices, including decreased travel, physical distancing, hospital and clinic avoidance, improved infection prevention and control, hand hygiene, and environmental cleaning may alleviate some of the impact of COVID-19 mediated antibiotic use on AMR ( 176 ). However, disproportionately high use of antibiotics in patients with COVID-19 has the potential to exacerbate this public health threat ( 177 ), particularly in areas where AMR is already a significant problem, such as China ( 178 ), Italy ( 179 ), and the US ( 180 ).…”

Prevalence of Co-infection at the Time of Hospital Admission in COVID-19 Patients, A Multicenter Study

“…These findings suggest that isolated signs of bCAP cannot be relied upon to make antibiotic decisions in patients with COVID-19. Prior studies [ 9 , 10 , 14 ] have found relatively high rates of antibiotic use in COVID-19 patients, raising concerns for the global impact of the pandemic on driving antimicrobial resistance, as was observed with the SARS-CoV-1 outbreak [ 18 , 19 ]. In our study, most patients without evidence of bCAP and almost half of those with a low suspicion of bCAP had antibiotics discontinued at 48 hours.…”

Impact of the Coronavirus Disease 2019 Pandemic on Outpatient Antibiotic Prescriptions in the United States

“…The long-term impact of the COVID-19 pandemic on outpatient antibiotic prescribing and antimicrobial resistance (AMR) trends in the US is uncertain. Antibiotic usage will be influenced by diverse and interacting factors, including the resumption of deferred health care services, new developments in the management of COVID-19 such as validation of immunosuppressive treatments or protective vaccines, the epidemiology of severe acute respiratory syndrome coronavirus 2, influenza and other respiratory tract viral infections in 2020–2021, and indirect effects on public health delivery, health care resources, and economic systems [ 9 ]. Associations between community antibiotic use and AMR are complex, and attempts to evaluate them are complicated by unknown expected effect sizes, costs of surveillance, heterogeneity of clinical and stewardship practices, and other confounding factors [ 10 ].…”

“…Associations between community antibiotic use and AMR are complex, and attempts to evaluate them are complicated by unknown expected effect sizes, costs of surveillance, heterogeneity of clinical and stewardship practices, and other confounding factors [ 10 ]. As such, it is an oversimplification to assume that antibiotic prescription trends during the COVID-19 pandemic will correlate directly with AMR rates [ 9 ]. Data have not been published on US in-hospital antibiotic use during the pandemic.…”