Antimicrobial Resistance in Healthcare-Associated Infections During COVID-19
Summary
The coronavirus disease 2019 (COVID-19) pandemic has profoundly disrupted healthcare systems worldwide, creating conditions that have accelerated the emergence and spread of antimicrobial resistance (AMR) in healthcare-associated infections (HAIs). Surges in hospital admissions strained infection prevention measures and led to widespread empirical use of broad-spectrum antibiotics in severely ill patients, often in the absence of confirmed bacterial co-infections. At the same time, infection control programmes were reorganised or deprioritised, healthcare staffing was stretched by redeployment and absenteeism, and personal protective equipment (PPE) shortages curtailed routine hygiene practices. These factors combined to foster increased transmission of multidrug-resistant organisms in critical care and general ward settings. Modelling studies have highlighted how delayed implementation of COVID-19 control measures can select for resistant strains, while surveillance data from diverse regions reveal rises in carbapenem-resistant Enterobacterales and methicillin-resistant Staphylococcus aureus during pandemic peaks. Conversely, targeted stewardship interventions and timely enforcement of non-pharmaceutical measures have demonstrated capacity to mitigate both viral and bacterial transmission. The global significance of these trends lies in the risk of eroding decades of progress against HAIs, underscoring the need for resilient antimicrobial stewardship, robust surveillance systems and integrated infection control strategies that can withstand future public health emergencies.
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Antimicrobial Resistance in Healthcare-Associated Infections During COVID-19 publication trend
The graph below shows the total number of articles in antimicrobial resistance in healthcare-associated infections during covid-19 across all publications each year (not limited to Nature Index journals).
Technical terms
Multidrug-resistant organism (MDRO): A pathogen resistant to three or more classes of antimicrobial agents.
Healthcare-associated infection (HAI): An infection acquired during the course of receiving treatment in a healthcare facility.
Carbapenemase-producing Enterobacterales (CPE): Bacteria that produce enzymes capable of deactivating carbapenem antibiotics.
Empirical antibiotic therapy: Administration of antibiotics based on clinical judgement before pathogen identification.
Nosocomial transmission: Spread of pathogens within a healthcare setting from patient to patient or via healthcare workers.
References
- Collateral impacts of pandemic COVID-19 drive the nosocomial spread of antibiotic resistance: A modelling study. PLOS Medicine (2023).
- Impact of the COVID-19 pandemic on prevalence of highly resistant microorganisms in hospitalised patients in the Netherlands, March 2020 to August 2022.. Eurosurveillance (2023).
- Antibiotic Consumption During the Coronavirus Disease 2019 Pandemic and Emergence of Carbapenemase-Producing Klebsiella pneumoniae Lineages Among Inpatients in a Chilean Hospital: A Time-Series Study and Phylogenomic Analysis. Clinical Infectious Diseases (2023).
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