Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance

Jesús Rodríguez-Baño^{1

2

3}, Gian Maria Rossolini^{4

5}, Constance Schultsz⁶, Evelina Tacconelli⁷, Srinivas Murthy⁸, Norio Ohmagari⁹, Alison Holmes¹⁰, Till Bachmann¹¹, Herman Goossens¹², Rafael Canton^{13

14}, Adam P Roberts¹⁵, Birgitta Henriques-Normark^{16

17}, Cornelius J Clancy¹⁸, Benedikt Huttner¹⁹, Patriq Fagerstedt²⁰, Shawon Lahiri²⁰, Charu Kaushic^{21

22}, Steven J Hoffman²³, Margo Warren²⁴, Ghada Zoubiane²⁵, Sabiha Essack^{25

26}, Ramanan Laxminarayan²⁷, Laura Plant²¹

Affiliations

¹ Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain.
² Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain.
³ Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain.
⁴ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁵ Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
⁶ Department of Global Health - AIGHD Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁷ Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
⁸ BC Children's Hospital, University of British Columbia, Vancouver, Canada.
⁹ Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
¹⁰ Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.
¹¹ The University of Edinburgh, Edinburgh Medical School, Division of Infection and Pathway Medicine, UK.
¹² Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
¹³ Servicio de Microbiología. Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
¹⁴ Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
¹⁵ Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁶ Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
¹⁷ Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
¹⁸ University of Pittsburgh, Pittsburgh, PA, USA.
¹⁹ Division of Infectious Diseases, Geneva, University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
²⁰ JPIAMR Secretariat, Swedish Research Council, Stockholm, Sweden.
²¹ Institute of Infection and Immunity, Canadian Institutes of Health Research.
²² McMaster Immunology Research Center, Dept Pathology and Mol. Medicine, McMaster University, Hamilton, Ontario, Canada.
²³ Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Canada.
²⁴ Access to Medicine Foundation, Amsterdam, the Netherlands.
²⁵ International Centre for Antimicrobial Resistance Solutions (ICARS), Copenhagen, Denmark.
²⁶ Antimicrobial Research Unit, University of KwaZulu-Natal, Durban, South Africa.
²⁷ Center for Disease Dynamics, Economics & Policy, New Delhi, India.

PMID: 33772597
PMCID: PMC8083707
DOI: 10.1093/trstmh/trab048

Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance

Jesús Rodríguez-Baño et al. Trans R Soc Trop Med Hyg. 2021.

. 2021 Oct 1;115(10):1122-1129.

doi: 10.1093/trstmh/trab048.

Authors

Affiliations

¹ Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain.
² Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain.
³ Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain.
⁴ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁵ Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
⁶ Department of Global Health - AIGHD Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁷ Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
⁸ BC Children's Hospital, University of British Columbia, Vancouver, Canada.
⁹ Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
¹⁰ Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.
¹¹ The University of Edinburgh, Edinburgh Medical School, Division of Infection and Pathway Medicine, UK.
¹² Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
¹³ Servicio de Microbiología. Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
¹⁴ Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
¹⁵ Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁶ Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
¹⁷ Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
¹⁸ University of Pittsburgh, Pittsburgh, PA, USA.
¹⁹ Division of Infectious Diseases, Geneva, University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
²⁰ JPIAMR Secretariat, Swedish Research Council, Stockholm, Sweden.
²¹ Institute of Infection and Immunity, Canadian Institutes of Health Research.
²² McMaster Immunology Research Center, Dept Pathology and Mol. Medicine, McMaster University, Hamilton, Ontario, Canada.
²³ Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Canada.
²⁴ Access to Medicine Foundation, Amsterdam, the Netherlands.
²⁵ International Centre for Antimicrobial Resistance Solutions (ICARS), Copenhagen, Denmark.
²⁶ Antimicrobial Research Unit, University of KwaZulu-Natal, Durban, South Africa.
²⁷ Center for Disease Dynamics, Economics & Policy, New Delhi, India.

PMID: 33772597
PMCID: PMC8083707
DOI: 10.1093/trstmh/trab048

Abstract

Antibiotic use in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients during the COVID-19 pandemic has exceeded the incidence of bacterial coinfections and secondary infections, suggesting inappropriate and excessive prescribing. Even in settings with established antimicrobial stewardship (AMS) programmes, there were weaknesses exposed regarding appropriate antibiotic use in the context of the pandemic. Moreover, antimicrobial resistance (AMR) surveillance and AMS have been deprioritised with diversion of health system resources to the pandemic response. This experience highlights deficiencies in AMR containment and mitigation strategies that require urgent attention from clinical and scientific communities. These include the need to implement diagnostic stewardship to assess the global incidence of coinfections and secondary infections in COVID-19 patients, including those by multidrug-resistant pathogens, to identify patients most likely to benefit from antibiotic treatment and identify when antibiotics can be safely withheld, de-escalated or discontinued. Long-term global surveillance of clinical and societal antibiotic use and resistance trends is required to prepare for subsequent changes in AMR epidemiology, while ensuring uninterrupted supply chains and preventing drug shortages and stock outs. These interventions present implementation challenges in resource-constrained settings, making a case for implementation research on AMR. Knowledge and support for these practices will come from internationally coordinated, targeted research on AMR, supporting the preparation for future challenges from emerging AMR in the context of the current COVID-19 pandemic or future pandemics.

Keywords: COVID-19; antimicrobial resistance; public health; stewardship; surveillance.

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Figures

**Figure 1.**
Key recommendations for continued support for antimicrobial resistance (AMR) research for clinical, research and policy stakeholders.

See this image and copyright information in PMC

References

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Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance

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Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance

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