Epidemiology of Gram-negative bacteria during coronavirus disease 2019. What is the real pandemic?

Abstract

Purpose of reviewBacterial infections play a key role in hospital outcomes during the coronavirus disease 2019 (COVID-19) pandemic. Nonetheless, the global impact on the epidemiology of Gram-negative bacteria (GNB) and antibiotic resistance has not been clearly established.Recent findingsMultiple limitations exist in the current literature, in that substantial variability was observed with regard to methodology. Notwithstanding the heterogeneity, the evidence suggests that the COVID-19 pandemic had a substantial negative impact on global epidemiology with an increase in hospital-onset infections, associated with GNB. Similarly, an alarming increase in resistant GNB compared to prepandemic rates, was apparent. This was most evident for carbapenemase-producing Klebsiella pneumoniae (bloodstream infections), carbapenem-resistant Pseudomonas aeruginosa (ventilator-associated pneumonia), and carbapenem-resistant Acinetobacter baumannii (all infections). Significant variations were most apparent in the large, system-wide regional or national comparative assessments, vs. single-centre studies. Categorizing concurrent bacteria as co- or secondary-infections may be paramount to optimize standard of care.SummaryThe data from most studies signal the probability that COVID-19 accelerated resistance. However, multiple limitations intrinsic to interpretation of current COVID-19 data, prevents accurately quantifying collateral damage on the global epidemiology and antibiotic resistance amongst GNB. It is likely to be substantial and renewed efforts to limit further increases is warranted.

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

“…Langford et al reported that more than 60% of patients with COVID-19 who had a bacterial infection harbored a highly resistant organism [ 54 ]. However, multiple limitations intrinsic to the interpretation of COVID-19 data prevent accurate quantification of its impact on the global epidemiology of AMR [ 55 , 56 ].…”

Ten golden rules for optimal antibiotic use in hospitals: based on the publication statement of the International Network Group of the World Antimicrobial Resistance

“…Langford et al reported that over 60% of COVID-19 patients with bacterial infections had highly resistant microorganisms [54]. However, accurately quantifying the impact of COVID-19 on the global epidemiology of AMR is challenging due to limitations in interpreting COVID-19 data [55,56].…”

High-Dose Nebulized Colistin Methanesulfonate and the Role in Hospital-Acquired Pneumonia Caused by Gram-Negative Bacteria with Difficult-to-Treat Resistance: A Review

“…Carbapenem-based empiric antibiotic regimens have long been associated with improved outcomes and, thus, comprised the backbone of antibiotic therapy for this patient population [ 8 ]. However, alarming is the emergence of carbapenem-resistant Gram-negative bacteria (CR-GNB), which has raised global concern due to limited remaining treatment options and overall poor prognosis with existing regimens [ 9 ]. As such, new terminology has been used to describe these pathogens, specifically Gram-negative pathogens with difficult-to-treat resistance (DTR), practically defined as treatment-limiting resistance to all first-line agents, that is, all β-lactams, including carbapenems and β-lactamase inhibitor combinations, and fluoroquinolones [ 10 ].…”