Antimicrobial Resistance and Antimicrobial Stewardship: Before, during and after the COVID-19 Pandemic

Abstract

Antimicrobial resistance (AMR) is an ongoing phenomenon. It is a significant public health issue that has existed long before the coronavirus disease of 2019 (COVID-19) pandemic. It develops as microorganisms undergo genetic mutations that allow them to survive despite antimicrobial treatment. This process is highly associated with excessive and often unnecessary antimicrobial pharmacotherapy, which was often discussed during the COVID-19 pandemic. This article explores how the pandemic has affected antimicrobial stewardship by shifting the focus away from antimicrobial resistance, as well as the impact of enhanced antibiotic usage and measures such as lockdowns, mandatory testing and vaccination on antimicrobial resistance. Although these measures were regarded as successful in terms of limiting the pandemic, they have significantly contributed to an already escalating AMR issue. Outpatient methods in primary care and intensive care units aiming to prevent severe COVID-19 disease have contributed to the spread of multidrug-resistant bacteria, while laboratories burdened with COVID-19 testing have indirectly interrupted the detection of these bacteria. In this review, we summarize the pathogens whose AMRe has been greatly affected by COVID-19 measures and emphasize the importance of efficient antimicrobial stewardship in future pandemic and non-pandemic states to promote the responsible use of antibiotics and minimize AMR.

Pre- and Post-COVID-19 Antimicrobial Resistance Pattern of Pathogens in an Intensive Care Unit

“…Another study, conducted in a COVID-19 referral hospital in Iran, showed a significant overall resistance increase among Gram-negative bacteria, particularly P. aeruginosa and K. pneumoniae [ 25 ]. A review conducted by Khaznadar et al also revealed that Gram-negative pathogens were those with levels of antimicrobial resistance most affected by the overuse of antibiotics during the pandemic [ 26 ], while a retrospective study conducted in Greece showed an increasing trend in the incidence of resistant Gram-negative bacteria, particularly in ICUs, compared to the pre-pandemic period [ 27 ].…”

A Whole-Genome Sequencing-Based Approach for the Characterization of Klebsiella pneumoniae Co-Producing KPC and OXA-48-like Carbapenemases Circulating in Sardinia, Italy

“…Based on previous reports, which showed an increased AMR rate during the COVID-19 pandemic, particularly for Gram-negative bacteria, we hypothesize that the concomitant spread of SARS-CoV-2 may have partially facilitated the rapid dissemination of these MDR strains. This highlights the crucial need for strengthened infection prevention and control measures and enhanced antimicrobial stewardship in the post-pandemic era [ 68 , 69 ].…”

Evaluating Healthcare-Associated Infections in Public Hospitals: A Cross-Sectional Study

“…Our study highlighted a gradual increase in the prevalence of HAIs caused by Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae strains, particularly in the last two years of the study period, 2020 and 2021. Numerous recent scientific articles have demonstrated a significant rise in HAIs associated with these strains since the onset of the COVID-19 pandemic [24,25]. A review study published in June 2023 showed an overall increase in drug-resistant bacterial infections involving Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and other germs, correlating with the heightened use of antibiotics in COVID-19 admissions [26].…”