Reviewed by Geeta Sood, MD, ScM, Johns Hopkins University
This study looked at the incidence of isolation of antimicrobial resistance (AMR) and AMR infections across 10 million admissions and 243 hospitals during and beyond the COVID-19 pandemic (January 2018 -December 2022) in the United States using the PINC AI/Premier Healthcare database. The time periods were divided into prepandemic, (January 2018-December 2019), peak pandemic (March 2020-February 2022), and waning pandemic (March – December 2022). Hospital-onset infections were defined as clinical or surveillance cultures obtained after 3 days of admission and community-onset if cultures were obtained within the first three days of admission. Competing risk analysis was performed.
Six antimicrobial resistant organisms were followed, methicillin-resistant S. aureus (MRSA), vancomycin resistant Enterococci (VRE), extended-spectrum cephalosporin-resistant (carbapenem-susceptible) Enterobacterales (ECR-E), carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant P. aeruginosa (CR-PA), and carbapenem-resistant Acinetobacter baumannii (CRAB).
Overall AMR infection rates increased by 6.5% during the peak of COVID before returning to baseline with hospital-onset and community-onset AMR infections increasing by 31.5% and 1.8% respectively. The largest increases were seen in CRAB and CRE with 45.7% and 25.1% increases respectively. Hospital-onset CRAB increased by 151%, CRE increased by 62.2%, and CP-PA increased by 54.2%. These hospital-onset AMR infections remained elevated in the waning pandemic period. Conversely, MRSA decreased during the pandemic and continued to decrease during the waning pandemic period. Patient level factors (such as antibiotic exposure) but not hospital factors were associated with higher cumulative incidence function of hospital-onset AMR infections.
Reference:
Yek C, Mancera AG, Diao G, et al. Impact of the COVID-19 Pandemic on Antibiotic Resistant Infection Burden in U.S. Hospitals: Retrospective Cohort Study of Trends and Risk Factors. Ann Intern Med. 2025 Jun;178(6):796-807. doi: 10.7326/ANNALS-24-03078. Epub 2025 Apr 29. PMID: 40294418.