Increased antimicrobial resistance during the COVID-19 pandemic

Highlights

• Besides SARS-CoV-2 infection itself, increased antimicrobial resistance poses collateral damage in the COVID-19 pandemic.

• There has been a rapid increase in MDROs, pan-echinocandin-resistant C. glabrata and multi-triazole-resistant A. fumigatus.

• Cause is multifactorial, particularly high antibiotic use in COVID-19 patients with low rates of co-/secondary infection.

• Appropriate prescription, optimised antibiotic use and aggressive infection control may help prevent occurrence of MDROs.

ABSTRACT

In addition to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection itself, an increase in the incidence of antimicrobial resistance poses collateral damage to the current status of the COVID-19 (coronavirus disease 2019) pandemic. There has been a rapid increase in multidrug-resistant organisms (MDROs), including extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae, carbapenem-resistant New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), pan-echinocandin-resistant Candida glabrata and multi-triazole-resistant Aspergillus fumigatus. The cause is multifactorial and is particularly related to high rates of antimicrobial agent utilisation in COVID-19 patients with a relatively low rate of co- or secondary infection. Appropriate prescription and optimised use of antimicrobials according to the principles of antimicrobial stewardship as well as quality diagnosis and aggressive infection control measures may help prevent the occurrence of MDROs during this pandemic.