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Medical Journal of Europe

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CONGRESS

Changes in Antibiotic Resistance During COVID-19 Pandemics



Cheng Han1, Liu Xu1, Chen Hou1, He Li1





1 Department of Infectious Diseases, Beijing
Chaoyang Hospital, Capital Medical University, Beijing, China


Received: 4 October 2023

Accepted: 6 October 2023

Published: 11 October 2023

Keywords:

COVID-19, resistance, Acinetobacter

Corresponding author:

Liu Xu, Department of Infectious Diseases, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. liuxu.mdinfection@gmail.com

doi: 10.5281/zenodo.10424245 

ABSTRACT

In this study, it was aimed to compare the changes in antibiotic resistance profiles in Acinetobacter baummannii and Pseudomonas aeruginosa isolates between the pre-pandemisc and pandemics periods. A total of 87 Gram negative non-fermentary bacteria strains (53 Acinetobacter baummannii and 34 Pseudomonas aeruginosa) isolated from the tracheal aspirates of intensive care unit patients in 2018 and 2019 were included in the study as the pre-pandemics group. And a total of 69 strains (38 A. baumannii and 31 P. aeruginosa) isolated in 2021 and 2022 were enrolled as the pandemic strains. It was determined that the resistance rates of imipenem (p=0.001), amikacin (p=0.001), tobramycin (p=0.001), levofloxacin (p=0.015) and piperacillin-tazobactam (p=0.037) in Acinetobacter isolates increased significantly during the pandemic period compared to the pre-pandemic period. It was determined that the resistance rates of imipenem (p=0.029), amikacin (p=0.037), tobramycin (p=0.034), levofloxacin (p=0.037) and piperacillin-tazobactam (p=0.036) in Pseudomonas isolates increased significantly during the pandemic period compared to the pre-pandemic period. In conclusion, the findings from our study showed that there was a significant increase in antibiotic resistance in Acinetobacter and Pseudomonas isolates with the pandemic and that the pandemic had a reducing effect on treatment alternatives.

MJE 2023-4-14-16 (Han) – Changes in Antibiotic Resistance During COVID-19 Pandemics – doiDOWNLOAD

INTRODUÇÃO / INTRODUCTION

The COVID-19 pandemic has undeniably reshaped the global landscape of infectious diseases, prompting unprecedented challenges for healthcare systems worldwide. Amid the extensive focus on managing viral outbreaks, there exists a growing concern regarding the potential impact of the pandemic on antibiotic resistance—a silent crisis that may exacerbate the complexity of patient care. This research article delves into the intricate interplay between the COVID-19 pandemic and antibiotic resistance, exploring the shifts, challenges, and implications for microbial ecosystems and public health (1-3).

While the primary battle against COVID-19 centers on the SARS-CoV-2 virus, collateral effects on bacterial infections and antibiotic utilization have garnered attention. The intertwined relationship between viral and bacterial infections during the pandemic raises critical questions about alterations in antibiotic resistance patterns, as selective pressures induced by extensive antimicrobial use may potentially influence microbial populations (3-5).

The pandemic has witnessed a surge in antibiotic prescriptions, driven by a combination of factors such as the need for secondary bacterial infection management in COVID-19 patients and the challenges in distinguishing viral from bacterial infections clinically. This section explores the documented changes in antibiotic consumption patterns during the pandemic, shedding light on the potential implications for the development and spread of antibiotic resistance (1-4).

Disruptions in healthcare services, overwhelmed medical facilities, and altered patient pathways during the pandemic have implications for antibiotic stewardship programs. We assess the adaptability of such programs in the face of unprecedented challenges, including the need for rapid decision-making, resource constraints, and the imperative to strike a delicate balance between managing viral and bacterial infections (6-8).

In this study, it was aimed to compare the changes in antibiotic resistance profiles in Acinetobacter baummannii and Pseudomonas aeruginosa isolates between the pre-pandemisc and pandemics periods.

METHODS

A total of 87 Gram negative non-fermentary bacteria strains (53 Acinetobacter baummannii and 34 Pseudomonas aeruginosa) isolated from the tracheal aspirates of intensive care unit patients in 2018 and 2019 were included in the study as the pre-pandemics group. And a total of 69 strains (38 A. baumannii and 31 P. aeruginosa) isolated in 2021 and 2022 were enrolled as the pandemic strains.

Antibiotic resistance profiles were provided from the hospital records retrospectively. Intermediate resistance was accepted as resistance in the analyses.

Statistical analysis

Chi square test was used for comparisons of distributions between the groups, and p<0.05 was considered significant.

RESULTS

The median age of the patients was 45 years during the pre-pandemic period and 43 years during the pandemic period. A total of 56.2% of the patients were male.

Table 1. Resistance rates in Acinetobacter baumannii isolates.

Pre-pandemicsPandemicsp
n%n%
Imipenem2954,73386,80,001
Amikacin2750,93284,20,001
Tobramycin1935,82771,10,001
Levofloxacin4075,53694,70,015
Piperacillin-tazobactam4279,23694,70,037

It was determined that the resistance rates of imipenem (p=0.001), amikacin (p=0.001), tobramycin (p=0.001), levofloxacin (p=0.015) and piperacillin-tazobactam (p=0.037) in Acinetobacter isolates increased significantly during the pandemic period compared to the pre-pandemic period. (Table 1).

It was determined that the resistance rates of imipenem (p=0.029), amikacin (p=0.037), tobramycin (p=0.034), levofloxacin (p=0.037) and piperacillin-tazobactam (p=0.036) in Pseudomonas isolates increased significantly during the pandemic period compared to the pre-pandemic period. (Table 2).

Table 1. Resistance rates in Pseudomonas aeruginosa isolates.

Pre-pandemicsPandemicsp
n%n%
Imipenem1528,322710,029
Amikacin9171651,60,037
Tobramycin713,21445,20,034
Levofloxacin1018,91754,80,037
Piperacillin-tazobactam815,11548,40,036

DISCUSSION

During the COVID-19 pandemic period, there was a great increase in the number of patients admitted to intensive care, especially due to COVID-19, and the occupancy rates in intensive care units increased significantly (9-11). Despite the serious measures taken during the pandemic period, such as wearing masks and social distancing, the increase in patient density and the decrease in the number of healthcare personnel due to disease transmission caused hospital infection measures to not be implemented well. Accordingly, there has been an increase in hospital infections. Additionally, due to this increase and the intensive antibiotic treatment of COVID-19 patients, an increase in antibiotic resistance rates has been recorded. This study showed an increase in resistance rates in infectious bacteria (11-14).

Many studies have shown that resistance rates against bacterial isolates, which are generally the causative agent of infection, have increased in the COVID-19 pandemic. There has been a great increase against almost all antibiotics in a wide variety of hospital infection agents from many parts of the world. Many different bacteria have become more resistant to many different treatment alternatives, antibiotics, with the pandemic (3-9). In the present study it was found that resistance rates of imipenem, amikacin, tobramycin, levofloxacin and piperacillin-tazobactam in Acinetobacter isolates increased significantly during the pandemic period compared to the pre-pandemic period. These findings show that there is a significant increase in resistance rates with the pandemic in Acinetobacter isolates, which cause the most frequent and resistant nosocomial infections.

In the present study, it was determined that the resistance rates of imipenem, amikacin, tobramycin, levofloxacin and piperacillin-tazobactam in Pseudomonas isolates increased significantly during the pandemic period compared to the pre-pandemic period.These findings show that there is a significant increase in resistance rates with the pandemic in Pseudomonas isolates, which cause very frequent and resistant nosocomial infections. Additionally, the fact that a large increase in resistance was observed to all of these important antibiotics evaluated in this study may be a good indicator that the pandemic has caused an increase in resistance in bacteria in general.

In the wake of the COVID-19 pandemic, this study illuminates a concerning trajectory in the realm of antibiotic resistance, particularly in Acinetobacter and Pseudomonas isolates, two notorious culprits behind nosocomial infections. The surge in patient admissions, predominantly driven by COVID-19 cases, coupled with strained healthcare resources, has created an environment conducive to the escalation of hospital-acquired infections. Despite stringent preventive measures, the increased patient density and compromised healthcare personnel have hindered the effective implementation of infection control protocols, resulting in a notable uptick in hospital infections.

Alarmingly, the present study reveals a substantial elevation in resistance rates for key antibiotics—imipenem, amikacin, tobramycin, levofloxacin, and piperacillin-tazobactam—in both Acinetobacter and Pseudomonas isolates during the pandemic period compared to the pre-pandemic era. These findings underscore the profound impact of the pandemic on bacterial resistance dynamics, emphasizing the urgency of addressing this collateral consequence. The observed surge in resistance rates across these critical antibiotics suggests a broader, systemic challenge, potentially indicating a widespread increase in bacterial resistance during the pandemic.

As we navigate the aftermath of this global health crisis, strategies to mitigate the rise in antibiotic resistance must be prioritized. Strengthening infection control measures, bolstering healthcare infrastructure, and judiciously prescribing antibiotics are imperative steps to curtail the burgeoning threat of antimicrobial resistance. This study serves as a clarion call for sustained vigilance, research, and global collaboration to safeguard our healthcare systems against the enduring consequences of the COVID-19 pandemic on bacterial resistance patterns.

In conclusion, the findings from our study showed that there was a significant increase in antibiotic resistance in Acinetobacter and Pseudomonas isolates with the pandemic and that the pandemic had a reducing effect on treatment alternatives.

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