Abstract
Changes in hospitals’ daily practice due to COVID-19 pandemic may have an impact on antimicrobial resistance (AMR). We aimed to assess this possible impact as captured by the Greek Electronic System for the Surveillance of Antimicrobial Resistance (WHONET-Greece). Routine susceptibility data of 17,837 Gram-negative and Gram-positive bacterial isolates from blood and respiratory specimens of hospitalized patients in nine COVID-19 tertiary hospitals were used in order to identify potential differences in AMR trends in the last three years, divided into two periods, January 2018–March 2020 and April 2020–March 2021. Interrupted time-series analysis was used to evaluate differences in the trends of non-susceptibility before and after the changes due to COVID-19. We found significant differences in the slope of non-susceptibility trends of Acinetobacter baumannii blood and respiratory isolates to amikacin, tigecycline and colistin; of Klebsiella pneumoniae blood and respiratory isolates to meropenem and tigecycline; and of Pseudomonas aeruginosa respiratory isolates to imipenem, meropenem and levofloxacin. Additionally, we found significant differences in the slope of non-susceptibility trends of Staphylococcus aureus isolates to oxacillin and of Enterococcus faecium isolates to glycopeptides. Assessing in this early stage, through surveillance of routine laboratory data, the way a new global threat like COVID-19 could affect an already ongoing pandemic like AMR provides useful information for prompt action.
Highlights
Antimicrobial resistance (AMR) is globally rising and is considered an ongoing pandemic; infections caused by multidrug-resistant (MDR) bacteria contribute to an increasing number of deaths each year, with an estimated 700,000 deaths globally [1]
Klebsiella pneumoniae In K. pneumoniae blood isolates from Intensive Care Units (ICUs) patients (Figure 5), we did not find any difference in the slope of carbapenem non-susceptibility trend, since it was found to consistently be high during the whole study period, ranging for meropenem from 87.8% in the first quarter of 2018 to 88.6% in the first quarter of 2021
As for K. pneumoniae blood isolates from ICU patients, we found a significant difference in the slope of the non-susceptibility trend for meropenem, changing from the stable trend during the 2018–2019 period to a decreasing trend during the pandemic period, remaining, at a high level of resistance
Summary
Antimicrobial resistance (AMR) is globally rising and is considered an ongoing pandemic; infections caused by multidrug-resistant (MDR) bacteria contribute to an increasing number of deaths each year, with an estimated 700,000 deaths globally [1]. A European Centre for Disease Control and Prevention (ECDC) study on the health burden of antimicrobial resistance [2] estimated that about 33,000 people die each year in the EU/EEA as a direct consequence of an infection due to MDR bacteria. According to the World Health Organization (WHO), by 2 July 2021, there have globally been 182,319,261 COVID-19 cases, including. In Greece, by the 5th of July 2021, 426,963 COVID-19 cases had been reported and 12,743 deaths [5]. In order to combat COVID-19, several changes in practices that may have impacts on AMR have taken place, absorbing huge amounts of resources from public health and healthcare systems [6]
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