Baum Jonathan H J, Dörre Achim, Reichert Felix, Noll Ines, Feig Marcel, Eckmanns Tim, Sandfort Mirco, Haller Sebastian
Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany.
Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany.
BMC Microbiol. 2025 Jan 28;25(1):51. doi: 10.1186/s12866-024-03723-5.
Carbapenem-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) are among WHO's priority pathogens with antimicrobial resistance (AMR). Studies suggest potential impacts of the COVID-19-pandemic on AMR. We described changes in AMR incidence and epidemiology in Germany during the COVID-19-pandemic.
We used two independent datasets, statutory surveillance and laboratory-based Antibiotic Resistance Surveillance (ARS). We included statutory notifications of infections/colonisations of carbapenem-resistant Acinetobacter spp., Klebsiella pneumoniae, Escherichia coli (CRA/CRKP/CREC) and invasive MRSA. Using Poisson/negative binomial regression and assuming continued pre-pandemic (2015/2017-2020) trends, we projected hypothetical notifications as if the pandemic had not occurred. We quantified annual changes during the pandemic period (2020-2022) by comparing to observed notifications. Additional models considered inpatient reductions, seasonality, infections only, or resistant isolates from ARS.
CRA notified cases were reduced by -30% (95%CI -39%|-20%) in 2020, -23% (-36%|-8%) in 2021, but + 32% (+ 6%|+64%) higher in 2022 relative to hypothetical pre-pandemic projections. Changes were - 35%/-31%/+6% for CRKP, -40%/-61%/-48% for CREC and - 33%/-25%/-20% for MRSA. Statutory-models accounting for fewer inpatients, seasonality and infections only showed similar trends, as did ARS-models for resistant isolates and infections. International mobility for CRA, CRKP and CREC decreased in 2020-2021, then increased in 2022.
We observed significant reductions of AMR notifications and infections during 2020-2021, also when accounting for fewer inpatients. We conclude a genuine reduction of AMR spread occurred during the pandemic. Factors like fewer hospitalisations and reduced international mobility contributed. Rising international mobility may partly explain increases for CRA, CRKP and CREC in 2022. A solid understanding of AMR trends improves infection prevention and control.
耐碳青霉烯类革兰氏阴性菌和耐甲氧西林金黄色葡萄球菌（MRSA）是世界卫生组织确定的具有抗菌药物耐药性（AMR）的重点病原体。研究表明，新冠疫情可能对抗菌药物耐药性产生影响。我们描述了德国在新冠疫情期间抗菌药物耐药性的发病率和流行病学变化。
我们使用了两个独立的数据集，即法定监测数据和基于实验室的抗生素耐药性监测（ARS）数据。我们纳入了耐碳青霉烯不动杆菌属、肺炎克雷伯菌、大肠杆菌（CRA/CRKP/CREC）感染/定植以及侵袭性MRSA的法定报告。使用泊松/负二项式回归，并假设疫情前（2015/2017 - 2020年）的趋势持续，我们预测了如果没有疫情可能出现的报告数量。通过与实际观察到的报告数量进行比较，我们量化了疫情期间（2020 - 2022年）的年度变化。其他模型考虑了住院人数减少、季节性、仅感染情况或来自ARS的耐药菌株。
与假设的疫情前预测相比，2020年CRA报告病例减少了-30%（95%CI -39%|-20%），2021年减少了-23%（-36%|-8%），但2022年增加了+32%（+6%|+64%）。CRKP的变化分别为-35%/-31%/+6%，CREC为-40%/-61%/-48%，MRSA为-33%/-25%/-20%。考虑到住院人数减少、季节性和仅感染情况的法定模型显示出类似趋势，针对耐药菌株和感染情况的ARS模型也是如此。2020 - 2021年，CRA、CRKP和CREC的国际流动性下降，然后在2022年有所增加。
我们观察到2020 - 2021年抗菌药物耐药性报告和感染显著减少，即使考虑到住院人数减少的情况。我们得出结论，疫情期间抗菌药物耐药性的传播确实有所减少。住院人数减少和国际流动性降低等因素起到了作用。国际流动性增加可能部分解释了2022年CRA、CRKP和CREC的增加情况。对抗菌药物耐药性趋势的深入了解有助于改善感染预防和控制。
