Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance?

Monnet, Dominique; Harbarth, Stéphan Juergen

doi:10.2807/1560-7917.es.2020.25.45.2001886

Cited by 145 publications

(157 citation statements)

References 34 publications

(49 reference statements)

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“…This is not surprising, because of several reasons: difficulties for healthcare workers to adhere to standard precautions (long shifts wearing the same equipment and possible shortages of certain equipment); focus on self-protection rather than on cross-transmission of bacteria across patients; overcrowded wards; shortages of professionals with appropriate training in infection control procedures; and possible decreased laboratory ability to detect MDR carriage. 20 Since there is great concern about potential exacerbation of MDRO spread after the COVID-19 outbreak, it will be crucial to continue monitoring rates of antibiotic-resistant bacterial infections and implementing infection control measures, especially in this phase.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

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Tiseo

Giordano

et al. 2020

Journal of Antimicrobial Chemotherapy

130

134

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Background Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19. Objectives To identify predictors of superinfections in COVID-19. Methods Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred ≥48 h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections. Results Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11–29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5–39.5, P < 0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4–13.1, P < 0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2–11.8, P < 0.001); C-reactive protein on admission >7 mg/dl (OR 3.59, 95% CI 1.7–7.7, P = 0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1–7.2, P = 0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11 days, P < 0.001), while mortality rates were similar (18.8% versus 23.2%, P = 0.445). Conclusions The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.

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Section: Discussionmentioning

confidence: 99%

Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

Falcone

Tiseo

Giordano

et al. 2020

Journal of Antimicrobial Chemotherapy

130

134

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“…Despite this, it has been reported that up to 70% of COVID-19 patients received antibiotics, although only 10% had a bacterial superinfection [ 15 ]. Measures taken during the COVID-19 era could increase the long-term mortality due to the MDR bacteria and the impact of the pandemic on antimicrobial resistance should be elucidated [ 2 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the economic damage could be as catastrophic as the 2008–2009 global financial crisis [ 1 ]. The impact of COVID-19 pandemic on antimicrobial prescribing and multidrug-resistant (MDR) bacteria in the hospital setting is unknown [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Multidrug-Resistant Bacterial Infections in Geriatric Hospitalized Patients before and after the COVID-19 Outbreak: Results from a Retrospective Observational Study in Two Geriatric Wards

et al. 2021

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The impact of the COVID-19 pandemic on multidrug-resistant (MDR) bacteria is unknown. The purpose of this study was to assess prevalence, etiology, and association with mortality of MDR bacteria in older adult patients before and after the first peak of the COVID-19 pandemic in Italy. An observational retrospective study was conducted in two geriatric wards of the Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, and of the INRCA, IRCCS, Ancona, in the Marche Region, Italy, from December 2019 to February 2020 and from May to July 2020. A total of 73 patients (mean age 87.4 ± 5.9, 27.4% men) and 83 cultures (36 pre-COVID-19 and 47 post-COVID-19) were considered. Overall, 46 cultures (55.4%) reported MDR bacteria (50% in pre- and 59.6% in post-COVID-19 period, p = 0.384). MDR bacteria in bloodstream significantly increased in post-COVID-19 period (68.8% vs. 40.0% p = 0.038) and MDR bacteria in urine did not change (51.6 vs. 54.8%, p = 0.799). Escherichia coli was the main MDR bacterium in pre-COVID-19, p = 0.082 and post-COVID-19, p = 0.026. Among patients with MDR infection, in-hospital mortality was 37.5% and 68.8% in pre- and post-COVID-19, respectively (p = 0.104), and mortality at 30 days was higher in post-COVID-19 period (78.9% vs. 27.3%, p = 0.012). An increased number of MDR bacteria in bloodstream and mortality after MDR infection have been observed in the post-COVID-19 period.

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“…It is known that antimicrobial stewardship programmes in hospitals have the potential to significantly reduce incidence of infections with ARO ( Baur et al, 2017 ), with the main aim being to minimise the risk of antibiotic misuse leading to AMR. Thus, COVID-19 may directly increase the number of infections with ARO, with the specific problematic ARO being setting dependent ( Monnet and Harbarth, 2020 ).…”

Section: Covid-19 Impact On Amrmentioning

confidence: 99%

Antimicrobial resistance and COVID-19: Intersections and implications

Knight

Glover

McQuaid

et al. 2021

eLife

247

212

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Before the coronavirus 2019 (COVID-19) pandemic began, antimicrobial resistance (AMR) was among the top priorities for global public health. Already a complex challenge, AMR now needs to be addressed in a changing healthcare landscape. Here, we analyse how changes due to COVID-19 in terms of antimicrobial usage, infection prevention, and health systems affect the emergence, transmission, and burden of AMR. Increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce AMR pathogen selection and spread in the short term. However, the opposite effects may be seen if antibiotics are more widely used as standard healthcare pathways break down. Over 6 months into the COVID-19 pandemic, the dynamics of AMR remain uncertain. We call for the AMR community to keep a global perspective while designing finely tuned surveillance and research to continue to improve our preparedness and response to these intersecting public health challenges.

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Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance?

Cited by 145 publications

References 34 publications

Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

Multidrug-Resistant Bacterial Infections in Geriatric Hospitalized Patients before and after the COVID-19 Outbreak: Results from a Retrospective Observational Study in Two Geriatric Wards

Antimicrobial resistance and COVID-19: Intersections and implications

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