Increased antimicrobial resistance during the COVID-19 pandemic
Open accessAbstract
In addition to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection itself, an increase in the incidence of antimicrobial resistance poses collateral damage to the current status of the COVID-19 (coronavirus disease 2019) pandemic. There has been a rapid increase in multidrug-resistant organisms (MDROs), including extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae, carbapenem-resistant New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), pan-echinocandin-resistant Candida glabrata and multi-triazole-resistant Aspergillus fumigatus. The cause is multifactorial and is particularly related to high rates of antimicrobial agent utilisation in COVID-19 patients with a relatively low rate of co- or secondary infection. Appropriate prescription and optimised use of antimicrobials according to the principles of antimicrobial stewardship as well as quality diagnosis and aggressive infection control measures may help prevent the occurrence of MDROs during this pandemic.
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Cross-resistance between disinfectants and antimicrobials has been reported for several disinfectants and is associated with a further increase in AMR during the pandemic period.
“The phenomenon of cross-resistance between disinfectants and antimicrobials has been reported for several disinfectants and is associated with a further increase in AMR during the pandemic period [5, 10, 11].”
From Profiling the resistome and virulome of Bacillus strains used for probiotic-based sanitation: a multicenter WGS analysis (2025) · cites this paper as [10]
The 'Increasing incidence of antimicrobial resistance' section reports more multidrug-resistant organisms during the pandemic. However, the paper does not report cross-resistance between disinfectants and antimicrobials or link disinfectant use to that increase; its 'The resolution' section instead discusses disinfection as an infection-control measure. No page numbers are provided in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDuring the COVID-19 pandemic, when chemical disinfection increased, a significant increase in AMR was recorded.
“Consistent with this, during the COVID-19 pandemic, when chemical disinfection was significantly increased in both sanitary and non-sanitary settings, a significant increase in AMR was recorded [5, 10, 11, 21].”
From Profiling the resistome and virulome of Bacillus strains used for probiotic-based sanitation: a multicenter WGS analysis (2025) · cites this paper as [10]
The Abstract and ‘Increasing incidence of antimicrobial resistance’ section report increased antimicrobial resistance and multidrug-resistant organisms during the COVID-19 pandemic. The paper does not establish that chemical disinfection increased significantly in sanitary and non-sanitary settings; its Conclusions instead emphasize increased antimicrobial-agent use as a contributor. (LLM, conf=0.86)
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- Authors
- Lai, C.-C., Chen, S.-Y., Ko, W.-C., & Hsueh, P.-R.
- Affiliations
- Kaohsiung Veterans General Hospital (TW)
- National Taiwan University (TW)
- National Cheng Kung University (TW)
- Corresponding author
- Hsueh, Po-Ren
- Venue
- International Journal of Antimicrobial Agents
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 57
- Issue
- 4
- Pages
- 106324
- ISSN
- 0924-8579 (ISSN-L)
- PMC
- PMC7972869
- OpenAlex
- W3136861861
- Cited by
- 436
- References
- 52
- Citations by year
- 2026: 26 · 2025: 56 · 2024: 82 · 2023: 144 · 2022: 102 · 2021: 25
- FWCI
- 9.76
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Antimicrobial Agents (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Keywords
- antimicrobial resistance, COVID-19 pandemic, multidrug-resistant organisms, extended-spectrum beta-lactamase, Klebsiella pneumoniae, carbapenem resistance, New Delhi metallo-beta-lactamase, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, Candida glabrata, Aspergillus fumigatus, antimicrobial stewardship, infection control, antimicrobial prescribing, SARS-CoV-2
- MeSH terms
- Antimicrobial Stewardship, COVID-19, Anti-Bacterial Agents, Bacteria, Bacterial Infections, Drug Resistance, Microbial, Drug Utilization, Fungi, Humans, Mycoses, Incidence, Pandemics, Coinfection
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