Abstract

ANTIMICROBIAL RESISTANCE BEFORE AND AFTER THE COVID-19 PANDEMIC: A COMPREHENSIVE REVIEW OF EPIDEMIOLOGICAL TRENDS, ANTIBIOTIC CONSUMPTION PATTERNS, CLINICAL EVIDENCE, AND FUTURE CHALLENGES

Shubham Chavan*, Mohini Mishra, Pallavi Chakor, Kajal Gupta

ABSTRACT

Antimicrobial resistance (AMR) has grown into one of the most threatening global public health challenges; AMR is impairing global public health's ability to effectively prevent, diagnose, and treat infectious diseases and has greatly contributed to the burden of disease, death and physical healthcare costs globally. The AMR crisis was already accelerating globally as a result of the increasing prevalence of multidrug resistant pathogens along with inappropriate antibiotic use in human medical practice as well as agricultural and animal husbandry prior to the COVID-19 global pandemic. The emergence of COVID-19 introduced a multitude of new challenges to healthcare systems and dramatically altered patterns of antibiotic use and patterns of resistance development. This review article will comprehensively review (that is, evaluate and details of the AMR epidemiology and its developement) before and the after COVID-19 pandemic, with particular reference to the following: antibiotic use (exposure), trends of antibiotic resistance for the priority pathogens, interrupted or failure of antimicrobial stewardship programmes, and the issue of how that impacted current antibiotic resistance surveillance systems. There have been numerous reports and various studies which have concluded that even though co-infections (bacterial) were relatively uncommon in COVID-19 patients, empirical antibiotic use was widely used in COVID-19 patients, especially those who were hospitalised and/or in critical condition. This excess exposure to anti-microbials, combined with the overloading of the healthcare system globally and decreasing levels of stewardship activities has potentially increased the rate at which multi-drug resistant organisms have emerged and disseminated, including: Methicillin Resistant Staphylococcus aureus, Carbapenem-Resistant Acinetobacter baumannii, Carbapenem-Resistant Klebsiella pneumoniae, and Multi-Drug Resistant Pseudomonas aeruginosa. The enhanced infection prevention measures introduced as a result of the COVID-19 pandemic, such as improved hand hygiene; better use of Personal Protective Equipment (PPE) and cleaner/sterilised environments; could have contributed to a reduction in the transmission of certain healthcare-associated pathogens. The review also looks at challenges facing us in the future, strategies for creating antimicrobial stewardship; innovations in surveillance and diagnostics; the One Health approach; and policy recommendations to help mitigate the impact of AMR (antimicrobial resistance) in the post-COVID-19 world. Global collaboration will be crucial to ensuring continued global efforts in conducting appropriate surveillance; ensuring an appropriate and reasonable use of antimicrobials; and continuing to support research and innovation that will help maintain the effectiveness of antimicrobials and the ability to prevent future resistance threats.

Keywords: Antimicrobial resistance, COVID-19 pandemic, antibiotic consumption, antimicrobial stewardship, multidrug-resistant organisms, surveillance, One Health, public health.