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The Impact of COVID-19 on Global Antibiotic Usage and Resistance Increases: A Comprehensive Analysis

Emerging research highlights the profound influence the COVID-19 pandemic has exerted on trends in antibiotic usage and the subsequent rise of antibiotic resistance. Two landmark studies reveal worrying patterns apropos these public health challenges. One report, spearheaded by researchers from the World Health Organization (WHO), substantiates prior findings of extensive global antibiotic administration in COVID-19 cases, which contradict comparatively low occurrences of suspected bacterial infections. Parallel research led by the National Institutes of Health (NIH), brings to light the alarming persistence of high rates of hospital-incurred, multidrug-resistant infections in US healthcare facilities, notably surpassing pre-pandemic levels.

These pivotal studies will be showcased at the forthcoming European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global Congress, taking place in Barcelona, Spain. WHO data harnessing the Global Clinical Platform revealed variations in antibiotic usage among 592,898 COVID-19 patients from 65 nations, recorded between January 2020 and March 2023. This usage fluctuated from 83% in the WHO Eastern Mediterranean Region to 32.8% across the Western Pacific Region, indicating that approximately three out of every four COVID-19 patients globally receive antibiotics, despite their inefficacy against the viral disease. Patients with severe or critical COVID-19 exhibited the highest rate of antibiotic usage, with 81% undergoing antibiotic regimen. Even among mild or moderate COVID-19 patients, antibiotic application was commonplace. Empirical treatment was not unusual, increasingly found in 55% of mild/moderate cases and 69% of severe/critical cases.

Although antibiotic practices in treating COVID-19 have declined over time in some regions, they have conversely escalated in Africa. Antimicrobial resistance (AMR), a silent but imminent threat aggravated by antibiotic misuse, is a growing concern for the WHO. Perturbingly, antibiotics with amplified risks of fostering resistance, categorized as ‘Watch’ antibiotics under the WHO’s AWaRE (Access, Watch, and Reserve) system, were frequently allocated to COVID-19 cases in certain global regions. Even so, empirical grounds to administer antibiotics to COVID-19 patients are scarce, as only a small fraction (8%) were reported with suspected bacterial co-infections. Antibiotics failed to scale up clinical outcomes for COVID-19 patients. In fact, patients without confirmed or suspected bacterial infections who received empirical antibiotic therapy faced an increased risk (80% for mild/moderate cases, 16% for severe/critical cases) of mortality. Data collected across 120 US hospitals from January 2018 to December 2022 underline the upsurge in AMR during the pandemic, fueled chiefly by a dramatic swell in hospital-acquired infections.

The rise in antibiotic usage in severely ill COVID-19 patients, compromised infection control protocols due to overburdened hospitals, exacerbated by staff shortages and strains in personal protective equipment, are speculated to contribute towards this trend. An inverse correlation was noted between the prevalence of community-acquired infections, which fell 10%, likely due to limited social interactions during the pandemic, and the surge in hospital-acquired AMR infections, which saw an increase of up to 160% with certain pathogens. Future measures are indispensable to safeguard people from insidious hospital-acquired gram-negative infections that linger alarmingly high. Global health groups argue for real-time monitoring in light of evolving developments that include a novel reassortant in Asia and increasing detections in mammals. Researchers emphasize the role of effective policy implementation and compliance in tackling these health issues.


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