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Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance?
Since 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 [1]. 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 [2]. 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.
While experts have warned of the link between COVID-19 and AMR [3-8], 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 [9-12]. Further studies have reported cases of antimicrobial-resistant invasive fungal infections in COVID-19 patients [13,14], and one case of azole-resistant Aspergillus spp. infection in an immunocompetent COVID-19 patient [15]. However, other studies from France and Spain did not show an increase in infections with multidrug-resistant bacteria [16,17], and one Italian study even saw a reduction in Clostridioides difficile infections in hospitalised patients [18]. 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 [19].
These 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 [8,20]. 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 [5]. As pointed out by Nieuwlatt et al. [21], 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.
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Since 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 [1]. 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 [2]. 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.
While experts have warned of the link between COVID-19 and AMR [3-8], 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 [9-12]. Further studies have reported cases of antimicrobial-resistant invasive fungal infections in COVID-19 patients [13,14], and one case of azole-resistant Aspergillus spp. infection in an immunocompetent COVID-19 patient [15]. However, other studies from France and Spain did not show an increase in infections with multidrug-resistant bacteria [16,17], and one Italian study even saw a reduction in Clostridioides difficile infections in hospitalised patients [18]. 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 [19].
These 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 [8,20]. 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 [5]. As pointed out by Nieuwlatt et al. [21], 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.
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