New study reports a sudden rise in antibiotic-resistant bacterial infections in US hospitals.

Antimicrobial resistance is more prevalent among COVID-19 and non-SARS-COV-2 patients hospitalized during the pandemic than it was pre-pandemic, according to a study conducted in 271 US institutions.

According to a study evaluating the pandemic’s impact on antimicrobial resistance (AMR) in 271 hospitals across the United States, both COVID-19 patients and those tested for SARS-COV-2 but negative had higher rates of antibiotic-resistant bacterial infections than patients hospitalized before the pandemic. The findings to be presented ECCMID.

In addition, the study found that drug-resistant infections were much more common in people who came to the hospital during the pandemic.

Antibiotic-resistant diseases killed an estimated 1.2 million people worldwide in 2019, and the figure is expected to rise tenfold by 2050. The COVID-19 pandemic poses many challenges for antibiotic stewardship, and studies have found that the pandemic is linked to AMR secondary infections, possibly as a result of increased antibiotic use to treat COVID-19 patients and disruptions to infection prevention and control practices in overburdened health systems. While solid evidence is still missing, these signals highlight the need of continuing to monitor COVID-19’s impact on AMR rates.

Researchers conducted a multicenter, retrospective cohort analysis of all adults (aged 18 years or older) admitted to 271 hospitals across the United States before and during the COVID-19 pandemic, who had spent at least one day in hospital and had a record of discharge or death, in order to provide more evidence.

Patients were categorized 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-19 status (with a positive SARS-CoV-2 result defined by positive PCR or antigen test within 7 days prior to admission or during hospitalisation). All admissions with at least one AMR infection (defined as a first positive culture for select gram-negative or gram-positive pathogens resistant to antibiotics) were recorded.

Researchers assessed AMR rates per 100 admissions before and during the COVID pandemic, and examined whether drug-resistant infections were acquired in the community-onset setting (defined as a culture collected less than 2 days after admission) or in the hospital-onset setting (more than 2 days after admission).

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 the hospital with at least one AMR infection was 63,263 in the pre-pandemic period and 129, 410 during the pandemic.

The analyses found that the AMR 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 AMR than patients before the pandemic—4.92 per 100 admissions and 4.11 per 100 admissions, respectively (see table in notes to editors).

For hospital-associated infections, the AMR rate was 0.77 per 100 admissions before the pandemic and 0.86 per 100 admissions during the pandemic, and highest at 2.19 per 100 admissions in patients with COVID-19. When looking at community-onset infections, the AMR rate was 2.76 per 100 admissions in the pre-pandemic period, and 2.61 per 100 admissions during the pandemic.

Despite these important and timely findings, the authors note that additional evaluation of the pandemic’s impact on antimicrobial resistance is needed.​

The scope of this study is limited to US hospitals, and further research into the impact of COVID-19 on AMR outside of the US is needed.

Image Credit: Getty

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