Boccabella Lucia, Palma Elena Gialluca, Abenavoli Ludovico, Scarlata Giuseppe Guido Maria, Boni Mariavirginia, Ianiro Gianluca, Santori Pierangelo, Tack Jan F, Scarpellini Emidio
Internal Medicine Unit, Madonna del Soccorso General Hospital, Via Luciano Manara 7, 63074 San Benedetto del Tronto, Italy.
Internal Medicine Clinics, Riuniti University Hospital, Polytechnics University of Marche, 60121 Ancona, Italy.
Antibiotics (Basel). 2024 Feb 29;13(3):233. doi: 10.3390/antibiotics13030233.
Antimicrobial resistance (AMR) is a chronic issue of our Westernized society, mainly because of the uncontrolled and improper use of antimicrobials. The coronavirus disease 2019 (COVID-19) pandemic has triggered and expanded AMR diffusion all over the world, and its clinical and therapeutic features have changed. Thus, we aimed to review evidence from the literature on the definition and causative agents of AMR in the frame of the COVID-19 post-pandemic era.
We conducted a search on PubMed and Medline for original articles, reviews, meta-analyses, and case series using the following keywords, their acronyms, and their associations: antibiotics, antimicrobial resistance, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), COVID-19 pandemic, personal protective equipment.
AMR had a significant rise in incidence both in in-hospital and outpatient populations (ranging from 5 up to 50%) worldwide, but with a variegated profile according to the germ and microorganism considered. Not only bacteria but also fungi have developed more frequent and diffuse AMR. These findings are explained by the increased use and misuse of antibiotics and preventive measures during the first waves of the SARS-CoV2 pandemic, especially in hospitalized patients. Subsequently, the reduction in and end of the lockdown and the use of personal protective equipment have allowed for the indiscriminate circulation of resistant microorganisms from low-income countries to the rest of the world with the emergence of new multi- and polyresistant organisms. However, there is not a clear association between COVID-19 and AMR changes in the post-pandemic period.
AMR in some microorganisms has significantly increased and changed its characteristics during and after the end of the pandemic phase of COVID-19. An integrated supranational monitoring approach to this challenge is warranted in the years to come. In detail, a rational, personalized, and regulated use of antibiotics and antimicrobials is needed.
抗菌药物耐药性（AMR）是我们西方化社会长期存在的问题，主要原因是抗菌药物的无节制和不当使用。2019年冠状病毒病（COVID-19）大流行引发并扩大了AMR在全球的传播，其临床和治疗特征也发生了变化。因此，我们旨在回顾文献中关于COVID-19大流行后时代背景下AMR的定义和致病因素的证据。
我们在PubMed和Medline上搜索了原创文章、综述、荟萃分析和病例系列，使用了以下关键词、其首字母缩写及其组合：抗生素、抗菌药物耐药性、严重急性呼吸综合征冠状病毒2（SARS-CoV2）、COVID-19大流行、个人防护装备。
全球范围内，住院患者和门诊患者中AMR的发病率均显著上升（从5%到50%不等），但根据所考虑的病菌和微生物不同，情况各异。不仅细菌，真菌产生AMR的频率也更高且更广泛。这些发现可以通过SARS-CoV2大流行第一波期间抗生素使用增加和滥用以及预防措施来解释，尤其是在住院患者中。随后，封锁措施的减少和结束以及个人防护装备的使用，使得耐药微生物从低收入国家无差别地传播到世界其他地区，出现了新的多重耐药和泛耐药生物。然而，在大流行后时期，COVID-19与AMR变化之间没有明确的关联。
在COVID-19大流行阶段及结束后，某些微生物的AMR显著增加且特征发生了变化。未来几年有必要采取综合的超国家监测方法应对这一挑战。具体而言，需要合理、个性化且规范地使用抗生素和抗菌药物。
