Patients hospitalized during the pandemic, both those who underwent to the covid test like those who tested negative in the SARS-COV-2 test, had higher rates of antibiotic-resistant bacterial infections compared to patients hospitalized before the pandemic, according to a study evaluating the impact of the pandemic on antimicrobial resistance (AMR) in 271 US hospitals.
The study, which was presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Lisbon, Portugal, also found that drug-resistant infections were significantly higher in cases of the onset of the pandemic in hospitals.
It is estimated that in 2019 1.2 million people died worldwide from antibiotic-resistant infections, with this number projected to increase 10-fold by 2050. The covid pandemic presents many challenges to appropriate antibiotic use and management, and there have been studies suggesting that pandemic was associated with secondary AMR infections, possibly due to increased use of antibiotics to treat covid patients and disruptions to infection prevention and control practices in overwhelmed health systems.
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To provide further evidence, the researchers conducted a retrospective, multicenter cohort analysis of all adults (aged 18 years and older) admitted to 271 US hospitals before and during the covid pandemic, who had spent at least one day in the hospital and had a discharge or death record.
Patients were classified according to when they were admitted: before the pandemic (from July 1, 2019 to February 29, 2020), or during the pandemic (from March 1, 2020 to October 30, 2021), and based on their covid status (with a positive result for SARS-CoV-2 defined by a positive PCR or antigen test within 7 days prior to admission or during hospitalization).
All admissions with at least one AMR infection (defined as a first positive culture for certain gram-negative or gram-positive antibiotic-resistant pathogens) were recorded.
The researchers evaluated ADR rates per 100 admissions before and during the COVID pandemic, examining whether drug-resistant infections were acquired in the community-based setting of initiation (defined as a culture collected less than 2 days after admission) or in the initial hospital setting (more than 2 days after admission).
Antimicrobials
In total, 1,789,458 patients were admitted to the hospital in the pre-pandemic period and 3,729,208 during the pandemic. The number of patients admitted to hospital with at least one AMR infection was 63,263 in the pre-pandemic period and 129,410 during the pandemic.
The analyzes revealed that the ADR rate was 3.54 per 100 admissions before the pandemic and 3.47 per 100 admissions during the pandemic. However, patients who tested positive or negative for covid-19 had higher levels of ADRs than patients before the pandemic: 4.92 per 100 admissions and 4.11 per 100 admissions, respectively.
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Regarding hospital infections, the ADR rate was 0.77 per 100 admissions before the pandemic and 0.86 per 100 admissions during the pandemic, with the highest rate being 2.19 per 100 admissions in patients with covid-19. When community-based infections are analyzed, the AMR rate was 2.76 per 100 admissions in the pre-pandemic period, and 2.61 per 100 admissions during the pandemic.
“These new data highlight the importance of closely monitor the impact of covid in rates of antimicrobial resistance. Of particular concern is that antibiotic resistance has increased during the pandemic in both SARS-CoV-2 positive and negative patients. Hospital-acquired infections are a major concern, with rates of resistance to antimicrobial significantly higher during the pandemic than before,” the authors detail.