Li Weibin, Yang Xinyi, Liu Chaojie, Liu Xu, Shi Lin, Zeng Yingchao, Xia Haohai, Li Jia, Zhao Manzhi, Yang Shifang, Li Xiaojie, Hu Bo, Yang Lianping
School of Public Health, Sun Yat-sen University, Guangzhou, China.
School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
Front Public Health. 2024 Jul 17;12:1419344. doi: 10.3389/fpubh.2024.1419344. eCollection 2024.
The emergency response to the COVID-19 pandemic may disrupt hospital management activities of antimicrobial resistance (AMR). This study aimed to determine the changing AMR trend over the period in China when stringent COVID-19 response measures were implemented.
This retrospective study was conducted in a designated hospital for COVID-19 patients in Guangzhou, China from April 2018 to September 2021. The prevalence of 13 antimicrobial-resistant bacteria was compared before and after the COVID-19 responses through Chi-square tests. Interrupted time series (ITS) models on the weekly prevalence of AMR were established to determine the changing trend. Controlled ITS models were performed to compare the differences between subgroups.
A total of 10,134 isolates over 1,265 days were collected. And antimicrobial-resistant strains presented in 38.6% of the testing isolates. The weekly AMR prevalence decreased by 0.29 percentage point (95% CI [0.05-0.80]) after antimicrobial stewardship (AMS) policy, despite an increase in the prevalence of penicillin-resistant (from 0/43 to 15/43, < 0.001), carbapenem-resistant (from 20/1254 to 41/1184, = 0.005), and carbapenem-resistant (from 93/889 to 114/828, = 0.042). And the changing trend did not vary by gender (male vs. female), age (<65 vs. ≥65 years), service setting (outpatient vs. inpatient), care unit (ICU vs. non-ICU), the primary site of infection (Lung vs. others), and Gram type of bacteria (positive vs. negative).
The response to COVID-19 did not lead to an increase in overall AMR; however, it appears that management strategy on the prudent use of antimicrobials likely contributed to a sizable long-term drop. The frequency of several multidrug-resistant bacteria continues to increase after the COVID-19 epidemic. It is crucial to continue to monitor AMR when COVID-19 cases have surged in China after the relaxation of restriction measures.
对新型冠状病毒肺炎（COVID-19）大流行的应急响应可能会扰乱医院对抗菌药物耐药性（AMR）的管理活动。本研究旨在确定在中国实施严格的COVID-19应对措施期间AMR的变化趋势。
本回顾性研究于2018年4月至2021年9月在中国广州一家指定的COVID-19患者医院进行。通过卡方检验比较了COVID-19应对措施前后13种抗菌药物耐药菌的流行情况。建立了关于AMR每周流行率的中断时间序列（ITS）模型，以确定变化趋势。进行了对照ITS模型以比较亚组之间的差异。
在1265天内共收集了10134株分离株。38.6%的检测分离株中存在抗菌药物耐药菌株。抗菌药物管理（AMS）政策实施后，AMR的每周流行率下降了0.29个百分点（95%CI[0.05-0.80]），尽管耐青霉素（从0/43增至15/43，<0.001）、耐碳青霉烯（从20/125至41/1184，=0.005）和耐碳青霉烯（从93/889至114/828，=0.042）的流行率有所上升。并且变化趋势在性别（男性与女性）、年龄（<65岁与≥65岁）、服务环境（门诊与住院）、护理单元（重症监护病房与非重症监护病房）、感染的主要部位（肺部与其他部位）以及细菌的革兰氏类型（阳性与阴性）方面没有差异。
对COVID-19的应对并未导致总体AMR增加；然而，谨慎使用抗菌药物的管理策略可能促成了长期的显著下降。COVID-19疫情后，几种多重耐药菌的频率持续上升。在中国放松限制措施后COVID-19病例激增时，继续监测AMR至关重要。
