Increased antimicrobial resistance during the COVID-19 pandemic

Lai, Chih Cheng; Chen, Shey-Ying; Ko, Wen Chien; Hsueh, Po-Ren

doi:10.1016/j.ijantimicag.2021.106324

Cited by 329 publications

(290 citation statements)

References 50 publications

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“…High empiric use of broad-spectrum antibiotics observed for COVID-19 patients is heightening concern that antibiotic overuse during the COVID-19 pandemic will exacerbate the problem of antimicrobial resistance in microorganisms of clinical significance into the future. ( 36 , 37 , 38 ) The review by Rawson et al found that 72% of COVID-19 patients had received antibacterial therapy and that recorded agents tended to be broad-spectrum antibiotics prescribed empirically in both critical and non-critical settings. ( 10 ) A meta-analysis by Langford and colleagues of 3,338 hospitalised and critical COVID-19 patients across 24 studies reported that a majority of COVID-19 patients received antibiotics (71.9%, 95% confidence interval (CI): 56.1-87.7%).…”

Section: Multi-drug Resistance and Antimicrobial Stewardshipmentioning

confidence: 99%

The interface between COVID-19 and bacterial healthcare-associated infections

O'Toole

2021

Clinical Microbiology and Infection

129

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Background A wide range of bacterial infections occur in COVID-19 patients, particularly, in those with severe coronaviral disease. Some of these are community acquired co-infections. Objective To review recent data which indicate the occurrence of hospital-onset bacterial infections, including with antibiotic-resistant isolates, in COVID-19 patients. Sources Using PubMed, the literature was searched using terms including: “COVID-19”; “SARS-CoV-2”; “bacterial infection”; “healthcare-associated infection”; “antibiotic resistance”; “antimicrobial resistance”; “multi-drug resistance”; “ Streptococcus ”; “ Staphylococcus ”; “ Pseudomonas ”; “ Escherichia ”; “ Klebsiella ”; “ Enterococcus ”; “ Acinetobacter ”; “ Haemophilus ”; “MRSA”; “VRE”; “ESBL”; “NDM-CRE”; “CR-Ab”; “VRSA”; “MDR”. Content There is a growing number of reports of bacterial infections acquired by patients with severe COVID-19 after hospital admission. Antibiotic-resistant pathogens found to cause healthcare-associated infections (HAIs) in COVID-19 patients include Methicillin-Resistant Staphylococcus aureus (MRSA), New Delhi Metallo-β-lactamase-producing Carbapenem-Resistant Enterobacterales (NDM-CRE), Carbapenem-Resistant Acinetobacter baumannii (CR-Ab), Extended-Spectrum β-Lactamase (ESBL) Klebsiella pneumoniae , and Vancomycin-Resistant Enterococci (VRE). COVID-19 has impacted bacterial HAIs in a number of ways with an increase in the incidence of NDM-CRE and CR-Ab reported at some hospital sites compared to before the pandemic. Recommended guidelines for antimicrobial stewardship in COVID-19 patient treatment are discussed regarding minimisation of empiric broad-spectrum antibiotic use. Other studies have reported a decrease in MRSA and VRE cases that has been attributed to enhanced infection prevention and control (IPC) practices introduced to minimise intra-hospital spread of COVID-19. Implications Poorer outcomes have been observed in hospitalised COVID-19 patients with an antibiotic-resistant infection. While heightened IPC measures have been accompanied by a reduction in some HAIs at specific sites, in other situations, COVID-19 has been associated with an increase in bacterial HAI incidence. Further research is needed to define the cost-benefit relationship of maintaining COVID-19-related IPC protocols beyond the pandemic to reduce the burden of HAIs. In addition, the longer-term impact of high usage of certain broad-spectrum antibiotics during the COVID-19 pandemic requires evaluation.

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Section: Multi-drug Resistance and Antimicrobial Stewardshipmentioning

confidence: 99%

The interface between COVID-19 and bacterial healthcare-associated infections

O'Toole

2021

Clinical Microbiology and Infection

129

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“…The current situation is such that most bacterial pathogens are resistant to the frontline drugs like carbapenems, imipenem, and vancomycin, etc. The ongoing global pandemic due to SARS-CoV-2 has also dramatically enhanced the use of several antibiotics to treat the secondary bacterial infections among the patients (Rawson et al 2020a , b ), the impact of which on the AMR will be required to be assessed in due course (Knight et al 2021 ; Lai et al 2021 ; Rawson et al 2020a ).…”

Section: Introductionmentioning

confidence: 99%

Polymyxins, the last-resort antibiotics: Mode of action, resistance emergence, and potential solutions

Mohapatra¹,

Dwibedy²,

Padhy³

2021

J Biosci

119

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Infections caused by multi-drug resistant (MDR) bacterial pathogens are a leading cause of mortality and morbidity across the world. Indiscriminate use of broad-spectrum antibiotics has seriously affected this situation. With the diminishing discovery of novel antibiotics, new treatment methods are urgently required to combat MDR pathogens. Polymyxins, the cationic lipopeptide antibiotics, discovered more than half a century ago, are considered to be the last-line of antibiotics available at the moment. This antibiotic shows a great bactericidal effect against Gram-negative bacteria. Polymyxins primarily target the bacterial membrane and disrupt them, causing lethality. Because of their membrane interacting mode of action, polymyxins cause nephrotoxicity and neurotoxicity in humans, limiting their usability. However, recent modifications in their chemical structure have been able to reduce the toxic effects. The development of better dosing regimens has also helped in getting better clinical outcomes in the infections caused by MDR pathogens. Since the mid-1990s the use of polymyxins has increased manifold in clinical settings, resulting in the emergence of polymyxin-resistant strains. The risk posed by the polymyxin-resistant nosocomial pathogens such as the Enterobacteriaceae group, Pseudomonas aeruginosa , and Acinetobacter baumannii, etc. is very serious considering these pathogens are resistant to almost all available antibacterial drugs. In this review article, the mode of action of the polymyxins and the genetic regulatory mechanism responsible for the emergence of resistance are discussed. Specifically, this review aims to update our current understanding in the field and suggest possible solutions that can be pursued for future antibiotic development. As polymyxins primarily target the bacterial membranes, resistance to polymyxins arises primarily by the modification of the lipopolysaccharides (LPS) in the outer membrane (OM). The LPS modification pathways are largely regulated by the bacterial two-component signal transduction (TCS) systems. Therefore, targeting or modulating the TCS signalling mechanisms can be pursued as an alternative to treat the infections caused by polymyxin-resistant MDR pathogens. In this review article, this aspect is also highlighted.

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“…Together, these factors may contribute to further exacerbating the emergence of antimicrobial resistance [ 16 , 17 , 18 ], and the World Health Organization (WHO), to prevent this, issued guidance to discourage antibiotic therapy or prophylaxis for patients with mild or moderate COVID-19 symptoms unless there is a clinical indication of a bacterial infection [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Profile of Bacterial Infections in COVID-19 Patients: Antimicrobial Resistance in the Time of SARS-CoV-2

Stefanini

Renzi

Foddai

et al. 2021

Biology

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The global onset of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infections happened suddenly, hence imposing a rapid definition of effective therapeutic approaches. Antibiotics were included among the prophylactic agents because of both the similarity between SARS-CoV-2 and atypical pneumonia symptoms, and the immune-modulating and anti-inflammatory properties of such drugs. Although, this approach could exacerbate the emergence of antimicrobial resistance. To evaluate the impact of the COVID-19 pandemic on the spread and characteristics of bacterial infections, as well as on the frequency of antimicrobial resistance, we investigated and compared clinical bacterial strains isolated in an Italian hospital from COVID-19 patients and non-COVID-19 patients during and before the COVID-19 outbreak. Data clearly indicate the impact of the COVID-19 pandemic on bacterial infections: not only some bacterial species were found in either COVID-19 positive or in COVID-19 negative patients, but isolates from COVID-19 patients also showed higher levels of antimicrobial resistance. Nevertheless, despite some bacterial species were isolated only before or over the pandemic, no differences were observed among the antimicrobial resistance levels. Overall, these results recapitulate the current situation of microbial infections and could also provide an overview of the impact of COVID-19 on bacterial pathogens spread and resistance.

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Increased antimicrobial resistance during the COVID-19 pandemic

Cited by 329 publications

References 50 publications

The interface between COVID-19 and bacterial healthcare-associated infections

The interface between COVID-19 and bacterial healthcare-associated infections

Polymyxins, the last-resort antibiotics: Mode of action, resistance emergence, and potential solutions

Profile of Bacterial Infections in COVID-19 Patients: Antimicrobial Resistance in the Time of SARS-CoV-2

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