Increased antimicrobial resistance during the COVID-19 pandemic

Abstract

In addition to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection itself, an increase in the incidence of antimicrobial resistance poses collateral damage to the current status of the COVID-19 (coronavirus disease 2019) pandemic. There has been a rapid increase in multidrug-resistant organisms (MDROs), including extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae, carbapenem-resistant New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), pan-echinocandin-resistant Candida glabrata and multi-triazole-resistant Aspergillus fumigatus. The cause is multifactorial and is particularly related to high rates of antimicrobial agent utilisation in COVID-19 patients with a relatively low rate of co- or secondary infection. Appropriate prescription and optimised use of antimicrobials according to the principles of antimicrobial stewardship as well as quality diagnosis and aggressive infection control measures may help prevent the occurrence of MDROs during this pandemic.

Keywords: Antibiotic usage; Antimicrobial resistance; COVID-19; Multidrug-resistant organism.

Fig. 1

Monthly number of confirmed cases of COVID-19 in Taiwan (n = 447) and those treated at National Taiwan University Hospital (NTUH) (n = 17) during January–June 2020. The patient census of outpatient clinics, emergency department and inpatient-days of hospitalisation of NTUH during January–June 2019 and January–June 2020.

Fig. 2

Comparison of the number and rate of antimicrobial-resistant infections of clinically important bacterial species recovered from various clinical sources of patients treated at National Taiwan University Hospital (NTUH) between January–June 2019 and January–June 2020: (A) Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and non-Typhi Salmonella spp. (predominantly associated with community-acquired infections); and (B) Staphylococcus aureus, Enterococcus spp., Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii complex (causing community- and hospital-acquired infections). R, resistant to the indicated antibiotic; PCN, penicillin; EM, erythromycin; LVX, levofloxacin; TC, tetracycline; AMP, ampicillin; AMC, amoxicillin/clavulanate; SXT, trimethoprim/sulfamethoxazole; CTX, cefotaxime; CIP, ciprofloxacin; OX, oxacillin; VAN, vancomycin; IMP, imipenem; CAZ, ceftazidime; SAM, ampicillin/sulbactam. Differences in rates of resistance >5% between two time periods are indicated in boldface.