PRO: The COVID-19 pandemic will result in increased antimicrobial resistance rates
Open accessAbstract
We argue that the COVID-19 pandemic will result in increased antimicrobial resistance (AMR). Broad-spectrum antibiotic use is common among hospitalized COVID-19 patients and in excess of reported secondary infection rates, suggesting unnecessary prescribing. Selection pressure is likely to be particularly intense in COVID-19 epicentres and within non-epicentre hospital units dedicated to COVID-19 care. Risk factors that increase the likelihood of hospitalization or poor outcomes among COVID-19 patients, such as advanced age, nursing home residence, debilitation, diabetes and cardiopulmonary or other underlying systemic diseases, also predispose to AMR infections. Worry for AMR emergence is heightened since first-wave COVID-19 epicentres were also AMR epicentres. Disruptive direct and indirect effects of COVID-19 globally on economic systems, governance and public health expenditure and infrastructure may fuel AMR spread. We anticipate that the impact of COVID-19 on AMR will vary between epicentres and non-epicentres, by geographic region, hospital to hospital within regions and within specific hospital units.
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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 [11]
The Abstract and “Why might AMR arise?” argue that AMR may increase during the COVID-19 pandemic, particularly because of antibiotic selection pressure. Our copy does not report cross-resistance involving disinfectants or link disinfectant use to a further increase in AMR (searched: disinfectants, cross-resistance, biocides). (LLM, conf=0.82)
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 [11]
In “COVID-19 and AMR: what do we know?” (page unavailable), the paper recounts an anecdotal report of a slow increase in multidrug resistance at one New York health system, but also reports a decrease in Geneva and says neither account presented data. In “Why might AMR arise?” (page unavailable), it predicts that AMR may increase rather than documenting a significant increase. The cited passages do not link AMR to increased chemical disinfection. (LLM, conf=0.86)
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- Authors
- Clancy, C. J., Buehrle, D. J., & Nguyen, M. H.
- Affiliations
- University of Pittsburgh (US)
- VA Pittsburgh Healthcare System (US)
- Corresponding author
- Clancy, Cornelius J
- Venue
- JAC-Antimicrobial Resistance
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-07-17
- Volume
- 2
- Issue
- 3
- Pages
- dlaa049-dlaa049
- ISSN
- 2632-1823 (ISSN-L)
- PMC
- PMC7454644
- OpenAlex
- W3044722900
- Cited by
- 102
- References
- 17
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 9 · 2023: 18 · 2022: 27 · 2021: 31 · 2020: 5
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- JAC-Antimicrobial Resistance (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- 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
- Physical Sciences › Environmental Science › Pollution › Pharmaceutical and Antibiotic Environmental Impacts
- Keywords
- COVID-19 pandemic, antimicrobial resistance, broad-spectrum antibiotic use, secondary infection, selection pressure, nosocomial infections, antibiotic prescribing
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