We may have left the acute phase of the COVID-19 behind us, but the coronavirus pandemic’s legacy is still being felt in a number of ways – including the acceleration of antimicrobial resistance (AMR).
According the Centers for Disease Control and Prevention (CDC) figures, resistant hospital-onset infections and deaths both increased at least 15% in 2020, and the worrying trend continued into 2021.1 This was despite mortality from antimicrobial resistance decreasing by 18% overall and almost 30% in hospitals between 2012 and 20171.
So what drove such significant change during the pandemic and post-pandemic period, and what does it tell us about the importance of antimicrobial stewardship (AMS)?
Driving factors
Over time, microorganisms develop resistance to antimicrobials they were once susceptible to. This inevitable consequence of evolution is a leading cause of death globally, and appropriate stewardship, or preserving the effectiveness of existing agents by only using them when necessary, has long been recognized as a central part of response.2
COVID-19 changed prescribing processes and treatment priorities almost overnight. According to one paper, there was an overuse of antibiotics during this time for three main reasons: panic about an unknown disease, the virus having similar symptoms to pneumonia, and a higher death rate being recorded among people with weaker immunity.3
However, data have since shown that many of the administered antibiotics may have been unnecessary. One review of 154 studies of people with laboratory-confirmed SARS-CoV-2 infection across all healthcare settings and age groups found the prevalence of antibiotic prescribing was 74.6%, while the estimated bacterial co-infections were just 8.6%.4
At the same time, the operational challenges associated with soaring patient numbers made it difficult for teams to follow infection control measures within hospitals, allowing infections to proliferate.
An ongoing challenge
The step change in antibiotic use during the first phases of the pandemic is likely to have long-term consequences on the battle against AMR.
Data from the United States, for example, suggest the rise contributed to a significant increase in antimicrobial-resistant infections in hospitals between 2019 and 2020. Compared to the previous year, cases of Carbapenem-resistant Acinetobacter increased by 78%, antifungal-resistant Candida auris by 60%, and carbapenem-resistant Enterobacterales by 35% 2020. Antifungal-resistant Candida infections increased by 26%, and ESBL-producing Enterobacterales by 32%.
In a foreword to a CDC special report of the pandemic’s impact on AMR, the body’s director Rochelle Walensky MD- MPH, said: “As the pandemic pushed healthcare facilities, health departments, and communities near their breaking points in 2020, we saw a significant increase in antimicrobial use, difficulty in following infection prevention and control guidance, and a resulting increase in healthcare-associated, antimicrobial-resistant infections.”
In Europe, annual cases of Acinetobacter, a group of bacteria with high resistance to available antimicrobials, have more than doubled since 2019. Cases of Klebsiella pneumoniae infection jumped by 31% in 2020, and by 20% in 2021.5
Double down on stewardship
The evidence is clear: the empiric use of antibiotics in hospitalized patients with SARS-CoV-2 accelerated AMR and threatened global health security.
Redoubling our stewardship efforts is essential to turning the tide. Diagnostics, which can provide clinicians with all the information they need to make informed treatment decisions, are a crucial part of the jigsaw.
Antimicrobial susceptibility testing (AST), for example, allows teams to help ensure only the most appropriate agent is selected, with platforms like the Thermo Scientific™ Sensititre™ System producing a definitive minimum inhibitory concentration (MIC) result to determine the lowest possible dose to stop bacterial growth.
Now, more than ever, we need to use every weapon in our arsenal to hold back the tide of AMR.
Explore more resources:
 | Post-viral syndrome: Tackling the COVID-driven increase in AMR starts in the laboratoryHow did the coronavirus pandemic contribute to antimicrobial resistance? Our SmartNote looks at the data behind the facts. |
Guiding treatment decisions for the critically ill - when is a true MIC not a true MIC?Download our latest white paper to hear directly from the experts on the impact of definitive minimum inhibitory concentration (MIC) results on therapeutic treatment decisions and patient care | |
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References
- CDC. (2022). COVID-19 U.S. Impact On Antimicrobial Resistance. Available at: https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf Last accessed: 31 July 2023
- WHO. (2015). Global Action Plan On Antimicrobial Resistance. Available at: https://www.who.int/publications/i/item/9789241509763 Last accessed: 31 July 2023
- Malik, S. S., & Mundra, S. (2022). Increasing consumption of antibiotics during the COVID-19 pandemic: Implications for patient health and emerging anti-microbial resistance. Antibiotics, 12(1), 45.
- Langford, B. J., So, M., Raybardhan, S., Leung, V., Soucy, J. P. R., Westwood, D., ... & MacFadden, D. R. (2021). Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clinical microbiology and infection, 27(4), 520-531.
- ECDC & WHO. (2022). Antimicrobial resistance surveillance in Europe: 2020 data. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/Joint-WHO-ECDC-AMR-report-2022.pdf Last accessed: 31 July 2023