COVID patients receiving antibiotics worsened global antimicrobial resistance

By Jennifer Allford, for Antimicrobial Resistance - One Health Consortium

Over the course of the pandemic, millions of people around the world have been admitted to hospitals with COVID-19. And, because coronavirus symptoms can be hard to distinguish from pneumonia and other bacterial infections, many of these patients are prescribed broad-spectrum antibiotics.

In a recent published study, researchers with Alberta’s  Antimicrobial Resistance (AMR) – One Health Consortium have found this common hospital practice may be acting “as a catalyst” to increase global antimicrobial resistance (AMR).

“With COVID, we had lot of people that didn’t have specific symptoms and antibiotics were used before they were tested,” says Dr. Herman Barkema, DVM ,PhD, director of the consortium and scientific director of One Health at UCalgary (OH@UC).

“We wanted to set a foundation of what we know and how can we tailor our strategies best to combat this global threat,” says Dr. Ruwandi Kariyawasam, PhD, Clinical Microbiology Fellow at the University of Alberta. “It's been a learning curve throughout this pandemic, trying to find the right balance. As the pandemic continues, we're getting better at being able strategize and create a better response.”

The researchers searched databases for articles about COVID patients with resistant co-infections over the first 18 months of the pandemic, from November 2019 through May 2021. They analyzed the prevalence and types of resistant co-infecting organisms in different hospital settings and locations. A total of 1,959 patients met the researchers’ criteria. Of them, 29 per cent, or 569 patients, were identified to be infected with a number of organisms that are drug resistant.

Resistance levels increase around the world

“Our findings, in one of the first systematic reviews of its kind, suggest that levels of antimicrobial resistance are increasing in hospital patients during the COVID-19 pandemic and we need to focus on rapid diagnosis of COVID so that we can actually treat it as the viral disease that it is, and not treat with broad spectrum antibiotics to it that don't work and may cause harm,” says Dr. John Conly, MD, infectious diseases physician and professor of medicine at the Cumming School of Medicine.

The study reviewed data from patients hospitalized around the world and did not find much difference between different countries. “We wanted to combine all that data, look at it as a whole and say, okay, this is the overall rate of resistance,” says Kariyawasam.

“Even when we stratified it by geographical location, North America versus Europe versus Asia, we didn't find too much of a difference in terms of the rates of resistant organisms. That signals the fact that this is not a problem unique to one specific geographical area, but really all over the world.”

Continued surveillance needed

Further, there was little statistical difference between different hospital settings. Intensive care units in general tend to have a higher incidence of resistant organisms because patients receive more broad spectrum antibiotics, and can be put on ventilator support which extends the use of the drugs.

The researchers say more research is needed to fully understand AMR in COVID patients and to develop better surveillance, infection prevention and control and co-ordinated global effort to fight AMR.

“We need a lot of surveillance. We need more investment in viral diagnostics and those are the kind of things that will prevent unnecessary antibiotic treatments. Antimicrobial use will result in antimicrobial resistance,” says Barkema. “The world has become a very small place. And bugs don't stop at borders.”