COVID-19 and antibiotic resistance: what is the connection?

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Antibiotic resistance has increased in the United States during the COVID-19 pandemic. Dana Neely/Getty Images
  • New analysis suggests hospital-acquired antibiotic-resistant infections have increased in the USA during the pandemic.
  • The spike in antibiotic resistance in hospitals was particularly high among patients with COVID-19.
  • Researchers believe that the increased prescription of antibiotics and reduced infection control during the crisis may be partly responsible.
  • In contrast, the frequency of community-acquired resistant infections appeared to decrease during the pandemic.

Over time, bacteria and other microorganisms can develop resistance to antimicrobial medications, which include antibiotics, antivirals, antifungals and antiparasitics. This makes common infections increasingly difficult to treat and potentially fatal.

In 2019, 1.2 million people deaths from antimicrobial resistant (AMR) infections globally, and World Health Organization (WHO) estimates that the annual number of deaths will be multiplied by 10 by 2050.

Overprescription of antibiotics and poor infection control promote the development of drug resistance.

There have been concerns that the increased use of antibiotics to treat secondary infections associated with COVID-19 has accelerated the development of AMRs, but direct evidence is lacking.

According to a new US-based study, the pandemic has increased the rate of hospital-acquired AMR infections from pre-pandemic levels.

The authors presented their findings at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), which took place April 23-26 in Lisbon, Portugal.

The researchers compared the rate of AMR infections in 271 US hospitals between July 1, 2019 and February 29, 2020, with the rate between March 1, 2020 and October 30, 2021.

The total number of hospital admissions increased from 1,789,458, during the pre-pandemic period, to 3,729,208 during the pandemic. The number of admissions with at least one RAM infection were 63,263 and 129,410, respectively.

Overall, the RAM rate was 3.54 per 100 admissions before the pandemic and 3.47 per 100 admissions during the pandemic.

However, the rate was 4.92 in patients who tested positive for SARS-CoV-2, which is the virus that causes COVID-19.

Among those who tested negative for SARS-CoV-2, the rate was 4.11, while the rate was 2.57 among those who did not receive a test.

The researchers also looked at whether the patients had developed their infection before or after admission to hospital.

They defined infections that were cultured in the hospital laboratory 2 days or less after admission as ‘community-onset’ and those cultured more than 2 days after admission as ‘hospital-onset’. hospital”.

There was a drop in the rate of community-based RAM, from 2.76 before the pandemic to 2.61 during the pandemic.

Among patients whose infection began in hospital, however, the AMR rate fell from 0.77 to 0.86.

The rate of hospital onset AMR was highest among those who tested positive for SARS-CoV-2, at 2.18 per 100 admissions.

“This likely reflects multiple factors during the pandemic, including the potential higher severity of illness for COVID-19 patients, longer length of hospital stay, and infection control and antimicrobial stewardship practices. , especially at the start of the pandemic,” said one of the authors, Dr. Karri Bauer, a pharmacist working with pharmaceutical company Merck.

Dr. Bauer said Medical News Today that as the pandemic progressed, clinicians better understood which patients were at risk of developing bacterial infections.

“It is always important that infection control and antimicrobial stewardship is optimized to minimize hospital-acquired infections,” Dr. Bauer said.

“It is imperative to continue to assess antimicrobial resistance and identify strategies to mitigate this global health threat,” she added.

Dr. Aaron E. Glatt, chair of the department of medicine and chief of infectious diseases at Mount Sinai South Nassau in Oceanside, NY, said he believes an increase in antibiotic prescribing in hospitals during the pandemic has contributed to the increase in resistance.

“There are potentially long-term consequences if this isn’t resolved,” said Dr. Glatt, who was not involved in the study.

“Certainly our knowledge of COVID-19 has improved considerably and there is no need to normally prescribe antibiotics for the treatment of a new COVID-19 infection,” he said. DTM.

He added that other factors likely contributed to increased resistance during the pandemic, including longer hospital stays and secondary bacterial and fungal infections in patients with severe COVID-19.

Heavy use of steroids and other immunosuppressive agents may also have played a role, Dr. Glatt said.

“I think there are many lessons doctors can learn from this pandemic that could mitigate the development of resistance in future outbreaks,” he said.

Doctors should not prescribe antibiotics when there is no clear evidence that they are necessary or beneficial, said Dr. Glatt, spokesperson for the Infectious Diseases Society of America:

“[W]While it’s very difficult to watch and do nothing for a very sick patient, sometimes it’s better to do nothing than give the wrong therapy because you’re desperate. A basic rule of medicine remains — Primum non nocere – First do no harm.”

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