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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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“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]
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“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]
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Coronavirus Disease 2019, Superinfections, and Antimicrobial Development: What Can We Expect?
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Self-citationDissemination and Mechanism for the MCR-1 Colistin Resistance
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The distribution of antibiotic use and its association with antibiotic resistance
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Prescription Fill Patterns for Commonly Used Drugs During the COVID-19 Pandemic in the United States
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Invasive Aspergillosis as an Under-recognized Superinfection in COVID-19
Thompson, G. R., Cornely, O. A., Pappas, P. G., Patterson, T. F., Hoenigl, M., Jenks, J. D., Clancy, C. J., & Nguyen, M. H. (2020) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofaa242 · Cited by 85
Self-citation
Research works printed but not linked: 1
- Clancy, 2020, COVID–19, superinfections and antimicrobial development: what can we expect?, Clin Infect Dis
Cited by
Sorted by citations
Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis
Langford, B. J., So, M., Raybardhan, S., Leung, V., Soucy, J.-P. R., Westwood, D. J., Daneman, N., & MacFadden, D. R. (2021) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2020.12.018 · Cited by 934
Antimicrobial resistance and COVID-19: Intersections and implications
Knight, G. M., Glover, R. E., McQuaid, C. F., Olaru, I. D., Gallandat, K., Leclerc, Q. J., Fuller, N. M., Willcocks, S., Hasan, R., van Kleef, E., et al. (2021) · eLife · doi:10.7554/elife.64139 · Cited by 372
Antibiotic resistance associated with the COVID-19 pandemic: a systematic review and meta-analysis
Langford, B. J., Soucy, J.-P. R., Leung, V., So, M., Kwan, A. T. H., Portnoff, J. S., Bertagnolio, S., Raybardhan, S., MacFadden, D. R., & Daneman, N. (2022) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2022.12.006 · Cited by 249
O'Flynn, D., Lawler, J., Yusuf, A., Parle‐McDermott, A., Harold, D., Cloughlin, T. M., Holland, L., Regan, F., & White, B. (2021) · Analytical Methods · doi:10.1039/d0ay02098b · Cited by 101
Emerging Concern for Silver Nanoparticle Resistance in Acinetobacter baumannii and Other Bacteria
McNeilly, O., Mann, R., Hamidian, M., & Gunawan, C. (2021) · Frontiers in Microbiology · doi:10.3389/fmicb.2021.652863 · Cited by 153
Metadata
- 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
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Health Sciences › Medicine › Microbiology (medical) › 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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