The Impact of COVID-19 Pandemic on ESBL-Producing Enterobacterales Infections: A Scoping Review

Abstract

Several studies have reported an increased frequency of colonization and/or infection with antibiotic-resistant bacteria (ARB) during the COVID-19 pandemic. Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) are a group of bacteria with intrinsic resistance to multiple antibiotics, including penicillins, cephalosporins, and monobactams. These pathogens are easy to spread and can cause difficult-to-treat infections. Here, we summarize the available evidence on the impact of the COVID-19 pandemic on infections caused by ESBL-PE. Using specific criteria and keywords, we searched PubMed, MEDLINE, and EMBASE for articles published up to 30 March 2023 on potential changes in the epidemiology of ESBL-E since the beginning of the COVID-19 pandemic. We identified eight studies that documented the impact of COVID-19 on ESBL-E. Five studies were focused on assessing the frequency of ESBL-PE in patient-derived specimens, and three studies investigated the epidemiological aspects of ESBL-PE infections in the context of the COVID-19 pandemic. Some of the studies that were focused on patient specimens reported a decrease in ESBL-PE positivity during the pandemic, whereas the three studies that involved patient data (1829 patients in total) reported a higher incidence of ESBL-PE infections in patients hospitalized for COVID-19 compared with those with other conditions. There are limited data on the real impact of the COVID-19 pandemic on the epidemiology of ESBL-PE infections; however, patient-derived data suggest that the pandemic has exacerbated the spread of these pathogens.

Keywords: Enterobacterales extended-spectrum β-lactamase-producing Enterobacterales; antibiotic-resistant bacteria; multidrug-resistant organisms.

Figure 1

Factors that contribute to the colonization or infection with ESBL-PE.

Figure 2

The COVID-19 pandemic and its potential effects on ESBL-PE infections.

Figure 3

Outline of the literature search. Our search yielded a total of 767 articles, and 512 were rapidly excluded because they were considered irrelevant. The remaining 255 articles were further screened for titles and abstracts, and thereafter, 238 of them were excluded because some of them were case reports, some studies were review articles, and some reported other types of infections. Finally, 17 articles were subjected to a full text review, and 8 of them were found to fulfill the inclusion criteria and were therefore included in this scoping review.