The following is a summary of the “Antibiotic resistance associated with the COVID-19 pandemic: a systematic review and meta-analysis,” published in the March 2023 issue of Clinical Microbiology and Infections Disease by Langford et al.

Their primary objective was to characterize the influence of the COVID-19 pandemic on antimicrobial resistance (AMR) in different types of hospitals. All studies that looked at the effect of COVID-19 on AMR in any population were considered, and their influential factors were culled. Improvements in infection control and/or antimicrobial stewardship initiatives have been reported. Gram-negative and Gram-positive bacteria were pooled independently. The meta-analysis was conducted with a random-effects design. Only 28 of the initial 6,036 studies met inclusion criteria; of those, only 23 provided data for meta-analysis. 

Most research (n = 25, or 89%) was conducted in hospitals. Methicillin-resistant Staphylococcus aureus (incidence rate ratio 0.99, 95% CI: 0.67-1.47) and vancomycin-resistant enterococci (risk ratio 0.91, 95% CI: 0.55-1.49) cases were not affected by the COVID-19 pandemic. Incidence rate ratio 1.64, 95% CI: 0.92-2.92; risk ratio 1.08, 95% CI: 0.91-1.29) was found to increase, but this was not statistically significant. The same was true for carbapenem-resistant Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii. In addition, there was an increased risk of gram-negative AMR without reported enhanced infection prevention and control and/or antimicrobial stewardship programs initiatives (risk ratio 1.11, 95% CI 1.03-1.20).

No significant difference was found between the presence and absence of these programs, according to a test for subgroup differences (P 0.40). Especially among Gram-negative organisms in healthcare facilities, the COVID-19 pandemic may have accelerated the emergence and spread of AMR. However, there is substantial variation between studies in terms of both the AMR metrics employed and the reported rate of resistance. In the context of the current COVID-19 pandemic context, these results highlight the importance of enhanced infection prevention, antimicrobial stewardship, and AMR surveillance.

Source: sciencedirect.com/science/article/pii/S1198743X22006103