United States: COVID-19 pandemic shook the world; however the impact of the same is still seen across the world. Recently, it has been seen that the pandemic has also impacted antibiotic use and resistance. According to the study, the high rates of antibiotic use in COVID-19 patients was seen despite the low rates of suspected bacterial infections, as per cidrap.umn.edu.
In a particular inquiry, data assembled by investigators from the World Health Organization (WHO) affirmed the veracity. Conversely, in a separate exploration, a squad spearheaded by researchers from the National Institutes of Health (NIH) discovered that frequencies of hospital-contracted, multi-pharmaceutical-resistant infections at US medical centers endure well above pre-pandemic thresholds.
Both scrutinizes are slated for presentation at the forthcoming European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global Congress in Barcelona, Spain.
Among individuals afflicted with severe COVID, 81% were administered antibiotics.
The WHO statistics, amassed through the WHO Global Clinical Platform, indicate that among 592,898 COVID-19 patients admitted to hospitals in 65 nations from January 2020 through March 2023, the utilization of antibiotics fluctuated from 83% in the WHO Eastern Mediterranean Region to 32.8% in the Western Pacific Region. Overall, three out of four COVID-19 patients received antibiotics, notwithstanding antibiotics offering no advantage for the viral ailment, as reported by cidrap.umn.edu.
The maximum rate of antibiotic utilization was observed among patients grappling with severe or critical COVID-19, with 81% of them receiving antibiotics. However, even in individuals with mild or moderate COVID, antibiotics were frequently prescribed, with percentages as elevated as 79% in the African Region. Empirical treatment was commonplace, spanning from 55% of patients with mild/moderate COVID-19 to 69% in severe critical cases.
Whilst antibiotic prescription rates for COVID-19 dwindled over time in Europe and the Americas from the onset of the pandemic through 2022, they escalated in Africa.
Despite the well-documented frequent use of antibiotics in the initial months of the pandemic—when medical facilities were inundated, and few treatment avenues were accessible—the ongoing prescription of antibiotics for COVID well into the pandemic is disconcerting. The WHO expresses apprehension that this extensive overutilization of antibiotics is fostering the “silent propagation” of antimicrobial resistance (AMR).
Prescription of ‘Watch’ antibiotics soared as high as 94%
In another disquieting revelation, the data also reveals that antibiotics with an elevated propensity for promoting resistance—dubbed “Watch” antibiotics under the WHO’s AWaRE (Access, Watch, and Reserve) classification system—were frequently dispensed to COVID-19 patients in the Eastern Mediterranean Region (93.8%), the Region of the Americas (90.8%), and the African Region (91.1%), reports by cidrap.umn.edu claimed.
However, as unearthed in prior investigations, there is scant justification for prescribing antibiotics for individuals with COVID-19. Suspected bacterial co-infections—which could potentially warrant the utilization of antibiotics in certain instances—were documented in only a fraction (8%) of COVID-19 patients. Greater rates of bacterial co-infections were noted in the Region of the Americas (14.1%) and the Eastern Mediterranean Region (8.8%).
As anticipated, antibiotics did not reduce disease severity in COVID-19 patients. They are the tactical actions employed by physicians, nurses, and allied health professionals to diagnose, treat, and prevent diseases. Instead, the analysis of a set of patients whose influenza/pneumonia (as well as another respiratory bacterial infection) was not suspected/confirmed revealed that the risk of death in those with mild/moderate COVID-19 who underwent empirical antibiotic therapy (80% increased) was 1.80 times higher than in those who did not receive antibiotics.
When used on patients having critical/severe COVID-19 presentation, it was observed that they faced an increased risk of mortality as high as 16% (aHR, 1.16; 95% CI, 1.08 to 2.84).
“In case a patient is required to use antibiotics, the benefits sometimes surpass the possibility that the associated side effects or antibiotic resistance would have caused. Nevertheless, employing antimicrobials in excessive quantities would undoubtedly flood the environment with them, enhancing their transfer and likewise the probability of the rise of resistance.” As Silvia Bertagnolio, MD, of the Division for AMR WHO unit head for surveillance, evidence, and laboratory strengthening declared in her recent WHO communiqué.
“These data underscore the need for enhancements in the judicious utilization of antibiotics to mitigate unnecessary adverse ramifications for patients and populations,” she appended.
Upsurge in resistant, hospital-acquired infections
Simultaneously, the data from 120 facilities in the US recorded from Jan 2018 to Dec 2022 depict which the resistance increased enormously during the pandemic and mainly caused by worryingly high rise in hospital-acquired infections.
In the examination, researchers scrutinized all adult hospital admissions over the period for culture-confirmed infection by six pathogens: one is antimicrobial resistance for which methicillin-resistant Staphylococcus aureus is commonly raised along with vancomycin – and Enterococcus (VRE, ECR), carbapenem-resistant Enterobacterales The other one is hospital-acquired infectious diseases in which hospitalizations which lasts for more than three days are included.
The results necessitate the introduction of antibiotic use control practices as part of the general plan to reduce undesired patient consequences and also to protect the community. The authors aimed to provide the public with a new and improved prevention strategy similar to what the Centers for Disease Control and Prevention (CDC) had previously done. The reveal, in 2022, confirmed troubling increases in the six pathogens, at least 15% of them were drug-resistant, since the outbreak started, at hospitals nationwide for the year 2020, which brought the number of infected patients, counts of fatalities up by 15% and 15% respectively in 2019 and 2020.
A multicenter prospective, observational study by the US NIH has disclosed that the overall rate of the incidence of AMR infections in hospitals has risen by 6.3% during the pandemic, primarily because hospital-acquired infections increased from 32.4%-fold in contrast with community-acquired infections that inched up by only 1.4 During the COVID-19 pandemic, the hospital-acquired infections that went up most were centrally line-associated bloodstream infections (CRAB), 160.0%, carbapenem-resistant Enterobacteriaceae (CRE), 63.6%, carbapenem-resistant Klebsiella pneumoniae (CR-PA), 54.5%, The story may be reversed when MRSA is defined by community-acquired infections; they fell by 10 percent downward and it, the researchers claim, was linked to social diminishing interactions.
Multifarious factors at play
Analogous to the CDC exposition, the researchers opine that the surge in multidrug-resistant, hospital-acquired infections is likely the outcome of a confluence of pandemic-related factors.
“It is plausible that upsurges in severely afflicted COVID-19 patients during the pandemic synchronized with significant upsurges in antibiotic utilization and impediments following infection and prevention control protocols in strained hospitals,” principal author Christina Yek, MBBCh of the National Institute of Allergy and Infectious Diseases, expounded in an ESCMID press release.
“Additionally, hospitals may have grappled with shortages of personal protective equipment while treating sicker patients who were more inclined to necessitate the utilization of medical devices like ventilators, which would have augmented the propagation of antimicrobial-resistant infections,” cidrap.umn.edu
Yek and her associates also discerned that the hospitals witnessing the most substantial surges in severely afflicted COVID-19 patients experienced the most considerable increments in hospital-acquired AMR infections.
And while the overall prevalence of AMR infections in US hospitals reverted to pre-pandemic levels (a 0.2% escalation) by the culmination of 2022, hospital- acquired AMR infections persisted 13% above baseline, primarily due to sustained escalations in carbapenem-resistant gram-negative pathogens. From March to December 2022, CRE, CRAB, and CR-PA infections were 81%, 43%, and 38% above pre-pandemic levels.
Yek expressed trepidation regarding the persistence of these infections.
“More concerted action is imperative to safeguard individuals, particularly from arduously treatable hospital-acquired gram-negative infections that remain disconcertingly prevalent,” she asserted.