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Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance?

Dominique L Monnet, Stephan Harbarth

Eurosurveillance · 2020

doi:10.2807/1560-7917.es.2020.25.45.2001886

Abstract

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From PubMed Central, U.S. National Library of Medicine, as current on Oct 24, 2026. Paragraph numbers are ours, so an answer can point at one.

1Since the beginning of 2020, the ongoing coronavirus disease (COVID-19) pandemic has resulted in the deaths of more than 250,000 patients in the European Union/European Economic Area (EU/EEA) and the United Kingdom alone. By the end of 2020, as every year, bacterial infections with antimicrobial resistance (AMR) will have caused the deaths of more than 30,000 Europeans. AMR is another ongoing pandemic that often goes unnoticed by a majority of Europeans. Larry Kerr, co-chair of the Transatlantic Task Force on Antimicrobial Resistance, recently compared the AMR pandemic to a multitude of small fires that are much less visible than the single massive firestorm that is the COVID-19 pandemic.

2While experts have warned of the link between COVID-19 and AMR, studies report conflicting evidence. Several studies—from, in particular, Germany, Italy and the US—have reported outbreaks or an increase in infections with and/or acquisition of multidrug-resistant bacteria during the COVID-19 pandemic. Further studies have reported cases of antimicrobial-resistant invasive fungal infections in COVID-19 patients, and one case of azole-resistant Aspergillus spp. infection in an immunocompetent COVID-19 patient. However, other studies from France and Spain did not show an increase in infections with multidrug-resistant bacteria, and one Italian study even saw a reduction in Clostridioides difficile infections in hospitalised patients. In a rapid review, Fattorini et al. found that only 1.3% of 522 COVID-19 patients in intensive care units (ICUs), and apparently no COVID-19 patients in other units, developed a healthcare-associated superinfection with antimicrobial-resistant bacteria.

3These different experiences may just be the consequence of previous antibiotic prescribing and infection prevention and control (IPC) practices that resulted in varying background AMR prevalence, in particular in healthcare settings, in different countries. Still, antibiotic prescribing and IPC practices may change during the COVID-19 pandemic and AMR could either increase or decrease as a result of these changes. As pointed out by Nieuwlatt et al., COVID-19 and AMR are parallel and interacting health emergencies that have similarities and offer opportunities for mutual learning with regard to their control. But the question remains whether the AMR situation in Europe and elsewhere will worsen or improve as a consequence of the current COVID-19 pandemic.

4We summarised various determinants that may result in either an increase or, inversely, a decrease in AMR and found them to be balanced (Table). The truth is that the impact of the COVID-19 pandemic on AMR will only become clear in the coming months and years as data gradually become available. Changes in AMR will most likely vary depending on the setting—e.g. ICUs vs other hospital units, hospital vs community settings—and possibly between countries.

Keeping the momentum

5On the occasion of European Antibiotic Awareness Day (EAAD), the European Centre for Disease Prevention and Control (ECDC) will publish its annual reports on surveillance of AMR from the European Antimicrobial Resistance Surveillance Network (EARS-Net) and on surveillance of antimicrobial consumption in humans from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). Data up to 2019 are already available from the ECDC Surveillance Atlas of Infectious Diseases and the ESAC-Net database. The World Health Organization (WHO) Regional Office for Europe will also publish an update of its annual report of the Central Asian and European Surveillance of Antimicrobial Resistance (CAESAR), including data up to 2019. The European Medicines Agency (EMA) just published its 10th report on the European Surveillance of Veterinary Antimicrobial Consumption with data from 2018. ECDC, EMA and the European Food Safety Authority are currently working on a third Joint Interagency Antimicrobial Consumption and Resistance Analysis report, to be published in 2021, which will include a detailed One Health analysis based on data from 2016 to 2018. At the global level, the latest WHO Global Antimicrobial Resistance Surveillance System Early Implementation Report 2020 on AMR has data from 2018.

6Unfortunately, more recent data are not yet available from these networks to assess the impact of COVID-19 on AMR. As of December 2018, only nine EU/EEA countries used machine-to-machine links for reporting data from clinical laboratory information management systems to a national database on EU-notifiable diseases and on AMR, respectively. While the collection and analysis of certain data requires time, we obviously need to implement systems for AMR surveillance in Europe that can obtain data and provide results much faster, taking as examples those that have already been implemented or are being tested in some European countries or projects.

7In addition, specific studies will need to be performed to assess changes in antibiotic prescribing, IPC practices and their effect on AMR as a consequence of the COVID-19 pandemic. One important point that will require consideration is that the effects of changes in antibiotic prescribing and IPC practices on AMR is unlikely to be immediate, and that the necessary delays to observe these effects—as well as the thresholds above which changes in antibiotic prescribing and IPC result in an effect—will need to be taken into account when analysing data. We should learn from the COVID-19 pandemic, with its rapid turnover and use of whole genome sequencing data, and dynamic linkage of various health databases. Surveillance data based on clinical samples in particular, if focused only on bloodstream infections, may provide a distorted picture of the effect of COVID-19 on AMR since the effect may only manifest itself in other clinical sites or even only in the commensal flora. This means that studies based on existing surveillance data should be complemented by well-designed cohort studies with serial surveillance swabs, e.g. in ICUs and other high-risk units.

European Antibiotic Awareness Day and World Antimicrobial Awareness Week 2020

8On 18 November, we will celebrate the 13th EAAD, in partnership with the World Antimicrobial Awareness Week, from 18 to 24 November 2020. Much has happened in Europe since the first EAAD in 2008: repeated awareness campaigns took place, EU and national action plans were developed in most EU/EEA countries and regulatory actions, policy initiatives and interventions were enacted at EU and national levels. One example of EU regulatory action is provided in this issue by Opalska et al., who reviewed all EU post-authorisation procedures of harmonising product information for antibiotics from 2007 to 2020. The study found that the majority resulted in a restriction of indications for antibiotics, which could have contributed to decreasing their consumption and, ultimately, AMR. The authors are planning further studies on the effect of such regulatory actions on antimicrobial consumption to inform future policies.

9As suggested last year by Peñalva et al., there are signs that the many actions and initiatives implemented at EU and national levels may start to show their effects on antimicrobial consumption and AMR trends. Nevertheless, much remains to be done to prevent and control AMR in Europe. The most recent data from EARS-Net confirm that AMR is still a serious challenge for the EU/EEA. In particular, the percentages of Enterococcus faecium from bloodstream infections that are resistant to vancomycin almost doubled between 2015 and 2019. Resistance to carbapenems—a last-line group of antibiotics—continues to be a concern, with several countries reporting carbapenem-resistance proportions above 10% in Klebsiella pneumoniae, and very much higher in Pseudomonas aeruginosa and Acinetobacter species bloodstream infections. In this issue, a survey by Lötsch et al. provides further evidence on A. baumannii. Authors found that seven European countries report an endemic situation, while another nine report regional or inter-regional spread of specifically carbapenem-resistant A. baumannii, with national capacities for its surveillance and containment varying depending on the country. For example, only 23 of the 37 participating European countries had a surveillance system for reporting carbapenem-resistant A. baumannii, 15 had national recommendations or guidelines for its control and only eight countries had a national plan for its containment—only one of which was one of the seven endemic countries.

10The COVID-19 pandemic reminds us that compliance with IPC measures is critical to ensure the safety of hospitalised patients. Most IPC measures that are essential for controlling the spread of SARS-CoV-2 also contribute to reducing the spread of antimicrobial-resistant bacteria; these, together with antimicrobial stewardship programmes, must be maintained and strengthened. In the midst of the COVID-19 pandemic, we certainly must not give up on our efforts to prevent and control AMR and must stay united to preserve the effectiveness of antimicrobials.

References 52

1.
European Centre for Disease Prevention and Control (ECDC). COVID-19 situation update for the EU/EEA and the UK, as of 12 Nov 2020. Stockholm: ECDC. [Accessed: 12 Nov 2020]. Available from: https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea
Not in our library
2.
Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis · 2019
No notice
3.
SARS‐CoV‐2, bacterial co‐infections, and AMR: the deadly trio in COVID‐19? · 2020
No notice
4.
Cantón R Gijón D Ruiz-Garbajosa P Antimicrobial resistance in ICUs: an update in the light of the COVID-19 pandemic. Curr Opin Crit Care. 2020;26(5):433-41.
Not in our library10.1097/mcc.0000000000000755
5.
Donà D Di Chiara C Sharland M Multi-drug-resistant infections in the COVID-19 era: a framework for considering the potential impact. J Hosp Infect. 2020;106(1):198-9.
Not in our library10.1016/j.jhin.2020.05.020
6.
Tackling antimicrobial resistance in the COVID-19 pandemic · 2020
No notice
7.
McKenna M. Covid-19 may worsen the antibiotic resistance crisis. Boone: Wired. 23 Apr 2020. Available from: https://www.wired.com/story/covid-19-may-worsen-the-antibiotic-resistance-crisis/
Not in our library
8.
Murray AK The novel coronavirus COVID-19 outbreak: global implications for antimicrobial resistance. Front Microbiol. 2020;11:1020.
Not in our library10.3389/fmicb.2020.01020
9.
A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit · 2020
Not checked
10.
Nori P Szymczak W Puius Y Sharma A Cowman K Gialanella P Emerging co-pathogens: New Delhi Metallo-beta-lactamase producing Enterobacterales infections in New York City COVID-19 patients. Int J Antimicrob Agents. 2020;106179:106179.
Not in our library10.1016/j.ijantimicag.2020.106179
11.
Porretta AD Baggiani A Arzilli G Casigliani V Mariotti T Mariottini F Increased risk of acquisition of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) among a cohort of COVID-19 patients in a teaching hospital in Tuscany, Italy. Pathogens. 2020;9(8):635.
Not in our library10.3390/pathogens9080635
12.
Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work? · 2020
No notice
13.
Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020 · 2020
No notice
14.
Posteraro B Torelli R Vella A Leone PM De Angelis G De Carolis E Pan-echinocandin-resistant Candida glabrata bloodstream infection complicating COVID-19: a fatal case report. J Fungi (Basel). 2020;6(3):163.
Not in our library10.3390/jof6030163
15.
Meijer EFJ Dofferhoff ASM Hoiting O Buil JB Meis JF Azole-resistant COVID-19-associated pulmonary aspergillosis in an immunocompetent host: a case report. J Fungi (Basel). 2020;6(2):79.
Not in our library10.3390/jof6020079
16.
Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU · 2020
No notice
17.
Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, et al. Incidence of co-infections and superinfections in hospitalised patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2020;S1198-743X(20)30450-X.
Not in our library10.1016/j.cmi.2020.07.041
18.
Bentivegna E, Alessio G, Spuntarelli V, Luciani M, Santino I, Simmaco M, et al. Impact of COVID-19 prevention measures on risk of health care-associated Clostridium difficile infection. Am J Infect Control. 2020 Oct 5;S0196-6553(20)30891-9.
Not in our library10.1016/j.ajic.2020.09.010
19.
Fattorini L Creti R Palma C Pantosti A Unit of Antibiotic Resistance and Special PathogensUnit of Antibiotic Resistance and Special Pathogens of the Department of Infectious Diseases, Istituto Superiore di Sanità, Rome Bacterial coinfections in COVID-19: an underestimated adversary. Ann Ist Super Sanita. 2020;56(3):359-64.
Not in our library10.4415/ann_20_03_14
20.
European Centre for Disease Prevention and Control (ECDC). Surveillance Atlas of Infectious Diseases. Stockholm: ECDC. [Accessed: 23 Oct 2020]. Available from: https://atlas.ecdc.europa.eu/public/index.aspx
Not in our library
21.
Nieuwlaat R, Mbuagbaw L, Mertz D, Burrows L, Bowdish DME, Moja L, et al. Coronavirus Disease 2019 and antimicrobial resistance: parallel and interacting health emergencies. Clin Infect Dis. 2020:ciaa773.
Not in our library10.1093/cid/ciaa773
22.
European Centre for Disease Prevention and Control (ECDC). Antimicrobial consumption database (ESAC-Net). Stockholm: ECDC. [Accessed: 23 Oct 2020]. Available from: https://www.ecdc.europa.eu/en/antimicrobial-consumption/surveillance-and-disease-data/database
Not in our library
23.
World Health Organization Regional Office for Europe (WHO/Europe). Antimicrobial resistance – Publications. Copenhagen: WHO/Europe. [Accessed: 27 Oct 2020]. Available from: https://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/publications
Not in our library
24.
European Medicines Agency (EMA). European Surveillance of Veterinary Antimicrobial Consumption, 2020: sales of veterinary antimicrobial agents in 31 European countries in 2018 (EMA/24309/2020). Amsterdam: EMA; 2020. Available from: https://www.ema.europa.eu/en/documents/report/sales-veterinary-antimicrobial-agents-31-european-countries-2018-trends-2010-2018-tenth-esvac-report_en.pdf
Not in our library
25.
World Health Organization (WHO). Global antimicrobial resistance surveillance system (GLASS) report: early implementation 2020. Geneva: WHO; 26 May 2020. Available from: https://www.who.int/glass/resources/publications/early-implementation-report-2020/en/
Not in our library
26.
Leitmeyer KC Espinosa L Broberg EK Struelens MJ ECDC National Focal Points laboratory e-reporting survey group membersECDC National Focal Points laboratory e-reporting survey group Automated digital reporting of clinical laboratory information to national public health surveillance systems, results of a EU/EEA survey, 2018. Euro Surveill. 2020;25(39):1900591.
Not in our library10.2807/1560-7917.es.2020.25.39.1900591
27.
Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). Providing a Roadmap for Automated Infection Surveillance in Europe (PRAISE). Stockholm: JPIAMR. [Accessed: 27 Oct 2020]. Available from: https://www.jpiamr.eu/wp-content/uploads/2018/11/Summary_PRAISE.pdf
Not in our library
28.
López-Lozano JM Lawes T Nebot C Beyaert A Bertrand X Hocquet D THRESHOLDS study group A nonlinear time-series analysis approach to identify thresholds in associations between population antibiotic use and rates of resistance. Nat Microbiol. 2019;4(7):1160-72.
Not in our library10.1038/s41564-019-0410-0
29.
Dynamic linkage of COVID-19 test results between Public Health England’s Second Generation Surveillance System and UK Biobank · 2020
No notice
30.
Opalska A Kwa M Hubert Leufkens H Gardarsdottir H Enabling appropriate use of antibiotics: review of European Union procedures of harmonising product information, 2007 to 2020. Euro Surveill. 2020;25(45):2000035
Not in our library10.2807/1560-7917.es.2020.25.45.2000035
31.
Peñalva G Högberg LD Weist K Vlahović-Palčevski V Heuer O Monnet DL ESAC-Net Study GroupEARS-Net Study Group Decreasing and stabilising trends of antimicrobial consumption and resistance in Escherichia coli and Klebsiella pneumoniae in segmented regression analysis, European Union/European Economic Area, 2001 to 2018. Euro Surveill. 2019;24(46):1900656.
Not in our library10.2807/1560-7917.es.2019.24.46.1900656
32.
Lötsch F Albiger B Monnet DL Struelens M Seifert H Kohlenberg A European Antimicrobial Resistance Genes Surveillance Network (EURGen-Net) carbapenem-resistant Acinetobacter baumannii capacity survey group. Epidemiological situation, laboratory capacity and preparedness for carbapenem-resistant Acinetobacter baumannii in Europe, 2019. Euro Surveill. 2020;25(45):2001735.
Not in our library10.2807/1560-7917.es.2020.25.45.2001735
33.
Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;S1198-743X(20)30423-7.
Not in our library10.1016/j.cmi.2020.07.016
34.
Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020;ciaa530.
Not in our library10.1093/cid/ciaa530
35.
Beović B, Doušak M, Ferreira-Coimbra J, Nadrah K, Rubulotta F, Belliato M, et al. Antibiotic use in patients with COVID-19: a ‘snapshot’ Infectious Diseases International Research Initiative (ID-IRI) survey. J Antimicrob Chemother. 2020;dkaa326.
Not in our library10.1093/jac/dkaa326
36.
Abelenda-Alonso G Padullés A Rombauts A Gudiol C Pujol M Alvarez-Pouso C Antibiotic prescription during the COVID-19 pandemic: A biphasic pattern. Infect Control Hosp Epidemiol. 2020;41(11):1371-2.
Not in our library10.1017/ice.2020.381
37.
Mazdeyasna H Nori P Patel P Doll M Godbout E Lee K Antimicrobial stewardship at the core of COVID-19 response efforts: implications for sustaining and building programs. Curr Infect Dis Rep. 2020;22(9):23.
Not in our library10.1007/s11908-020-00734-x
38.
Furukawa D, Graber CJ. Antimicrobial stewardship in a pandemic: picking up the pieces. Clin Infect Dis. 2020;ciaa1273.
Not in our library10.1093/cid/ciaa1273
39.
European Association of Hospital Pharmacists (EAHP). 2018 EAHP Medicines shortages report. Medicines shortages in European hospitals. Brussels: EAHP; 2018. Available from: https://www.eahp.eu/sites/default/files/shortages_report05online.pdf
Not in our library
40.
ReAct – Action on Antibiotic Resistance. Shortages and AMR – why should we care? Four consequences of antibiotic shortages. ReAct; 12 Mar 2020. Available from: https://www.reactgroup.org/news-and-views/news-and-opinions/year-2020/shortages-and-amr-why-should-we-care-4-consequences-of-antibiotic-shortages/
Not in our library

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