COVID-19: Impact on prescribing and antimicrobial resistance

Abstract

The onset of the COVID-19 pandemic challenged healthcare systems focusing their activity on patients infected with SARS-CoV-2. Previous experience with co-infections and superinfections in patients infected with other coronaviruses (SARS-CoV and MERS), the influenza patients admitted to hospitals and prevention of the unknown led to the increased empirical use of broad-spectrum antibiotics in hospitals. The breakdown of antimicrobial stewardship and infection control programs determine an increase in infections due to multidrug-resistant bacteria, particularly in intensive care units. Most of these infections are related to high-risk carbapenemase-producing clones and occasionally with resistance to new β-lactam-β-lactamase inhibitor combinations. On the contrary, in the primary care, there has been a decrease in the use of antimicrobials during the first wave, although it would not have had a significant impact on pathogens associated with community-acquired infections. The accumulated experience reaffirms the need to maintain antimicrobial stewardship and infection control programs in future health crises.

Figure 1

Comparative antimicrobial consumption in Spain in 2019 and 2020. Data obtained from the national consumption surveillance system of the Spanish National Plan against antimicrobial resistance (https://resistenciaantibioticos.es/es/profesionales/vigilancia/mapas-de-consumo): Overall antimicrobial consumption in the hospital setting (A), the corresponding to third generation cephalosporins (B) and azithromycin (C), and in the primary care (D)