Changes in Antibiotic Resistance Before and During the COVID-19 Pandemic: Retrospective Surveillance Study in a Single Indonesian Tertiary Hospital

Abstract

Background: Antibiotic resistance is recognized as a public health threat with significant impacts on mortality and economic burdens. Antibiotic resistance related to inappropriate empiric antibiotics, particularly during the COVID-19 pandemic. However, limited information is available about changes in antibiotic resistance before and during the pandemic in Indonesia. This study aimed to describe changes in the prevalence of antibiotic resistance among patients with proven bacterial infections before and during the COVID-19 pandemic. Methods: A retrospective surveillance study was carried out at a single tertiary hospital to review medical records containing culture and antibiotic susceptibility data among hospitalized patients diagnosed with sepsis and COVID-19 according to the International Classification of Disease (ICD). In this context, the predefined periods were 1 January–31December 2019 and 1 March 2020–31 December 2021. The result was the percentage of resistance to selected antibiotics among the study population, stratified by gram-bacteria type, with the evaluation of changes in antibiotic resistance over time. Results: During the observation period, 596 adult patients were diagnosed with sepsis (before COVID-19), and 2786 were diagnosed with confirmed COVID-19 (during COVID-19). The rate of culture growth in patients with sepsis was greater than that in patients with COVID-19, with values of 51.6% and 29.2%, respectively. Gram-negative bacterial isolates were predominantly found in all observation periods, accounting for 41.2% - 47.3% of the adult middle-aged group. Changes in antibiotic resistance against GNB were observed during COVID-19 (peak phase, above 20%) compared to the early phase. For gram-positive bacteria, the greatestchanges were found in the late phase, reaching 70%. Conclusions: This study revealed that changes in antibiotic resistance before and during the COVID-19 pandemicaffected both GNB and GPB. High antibiotic use and age-related immune responses (i.e., immunosenescence) contributed to these rapid changes. Strengthening strategies, including implementing surveillance systems and antimicrobial stewardship programs and enhancing the capacity of healthcare workers, are recommended for combatting antibiotic resistance.