The Collateral Effects of COVID-19 Pandemic on the Status of Carbapenemase-Producing Pathogens

Abstract

The serious challenge of antimicrobial resistance continues to threaten public health and lingers in the era of the coronavirus disease 2019 (COVID-19), declared pandemic by the World Health Organization. While the pandemic has triggered the importance of infection control practices and preventive measures such as physical distancing, hand hygiene, travel reduction and quarantine, the ongoing alarm of antimicrobial resistance seems to accompany the pandemic too. Antimicrobial resistance has been fostered during COVID-19, possibly due to high rate of empirical antibiotic utilization in COVID-19 patients, increased use of biocides, and the disruption of proper healthcare for other conditions. Specifically, carbapenemase-producing Gram-negative bacteria have shown to cause secondary bacterial infections in patients hospitalized for COVID-19. Clinical and microbiological evidence of such infections is accumulating in different parts of the world. With the resilient nature of carbapenemases, their association with mortality, and the limited treatment options available, concerns regarding this group of antibiotic-hydrolyzing enzymes during the pandemic are expected to upsurge. While the additional burden carbapenemases exert on healthcare is worrisome, it remains hidden or abandoned among the various health consequences of the pandemic. The purpose of this minireview is to shed a light on carbapenemase-associated infections during such unprecedented time of COVID-19. A focused insight shall be made into carbapenemases, their implications for COVID-19 patients, and the features and consequences of co-infection, with a review of available evidence from pertinent literature. The importance of increased surveillance for carbapenemase-producers and optimizing their management in relation to the pandemic, shall be addressed as well.

Epidemiology and antimicrobial resistance trends of Acinetobacter species in the United Arab Emirates: a retrospective analysis of 12 years of national AMR surveillance data

“…Similarly, the proportions of MDR and possible XDR strains were almost reduced by half, indicating that some isolates have regained their sensitivity or at least ceased being nonsusceptible over the course of the follow-up years. The mild increase in the levels of MDR, possible XDR, and possible PDR strains toward the end of the study period may have been affected by the COVID-19, as reported elsewhere ( 66 , 67 ), and was probably driven by high rates of antimicrobial utilization and disruption of infection control measures occurring as collateral effects of the global pandemic ( 68 ). It is worth mentioning that trends in Acinetobacter species resistance were reported to have similar declining portraits in other parts of the world.…”

Prevalence and Impact on Mortality of Colonization and Super-Infection by Carbapenem-Resistant Gram-Negative Organisms in COVID-19 Hospitalized Patients

“…No carbapenemases other than KPC were identified among carbapenem-resistant Enterobacterales isolates. While during the early stages of the COVID-19 pandemic, unremarkable increases in the incidence of infections by carbapenemase-producing Enterobacterales were observed [ 26 , 27 ], such figures significantly changed later on [ 28 ]. Tiri et al reported that the incidence of KPC-producing Klebsiella pneumoniae in COVID-19 ICU patients increased significantly from 6.7% in 2019 to 50% in 2020 [ 29 ].…”

"Multidrug-Resistant Bacteria Related to Covid-19 Infection: A Minireview"

“…The systematic review study by Langford et al found no association between COVID-19 and changes in antimicrobial resistance of gram-positive bacteria. However, a possible increase in resistance was found in gram-negative patients, suggesting an important role due to the high use of beta-lactams and third generation cephalosporins in patients with COVID-19 [48,49]. The study by Elton and colleagues at two hospitals in Africa observed an increase in the total number of HAIs caused by multidrug-resistant bacteria in COVID-19 patients.…”