Academic Journal
Antimicrobial stewardship challenges during the COVID-19 pandemic: implications of antibiotic overuse and antimicrobial resistance.
| Τίτλος: | Antimicrobial stewardship challenges during the COVID-19 pandemic: implications of antibiotic overuse and antimicrobial resistance. |
|---|---|
| Συγγραφείς: | Špelić M; Health Institution Pharmacies Župančić, Popovača, Croatia., Krajinović V; Dr Fran Mihaljević Hospital for Infectious Diseases, Zagreb, Croatia. |
| Πηγή: | Arhiv za higijenu rada i toksikologiju [Arh Hig Rada Toksikol] 2026 Sep 25; Vol. 77 (3), pp. 160-168. Date of Electronic Publication: 2026 Sep 25 (Print Publication: 2026). |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Institut za medicinska istraz̆ivanja i medicinu rada Country of Publication: Croatia NLM ID: 0373100 Publication Model: eCollection Cited Medium: Internet ISSN: 1848-6312 (Electronic) Linking ISSN: 00041254 NLM ISO Abbreviation: Arh Hig Rada Toksikol Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2016>- : Zagreb, Croatia : Institut za medicinska istraz̆ivanja i medicinu rada Original Publication: Zagreb, Croatia : Institute for Medical Research and Occupational Health |
| Ιατρικοί όροι (MeSH): | Anti-Bacterial Agents*/therapeutic use , COVID-19*/epidemiology , Inappropriate Prescribing*/statistics & numerical data , Inappropriate Prescribing*/prevention & control , Bacterial Infections*/drug therapy , Practice Patterns, Physicians'*/statistics & numerical data , Antimicrobial Stewardship* , Drug Resistance, Microbial*, Coinfection/drug therapy ; Humans ; Pandemics ; Drug Resistance, Bacterial ; SARS-CoV-2 |
| Περίληψη: | The coronavirus disease 2019 (COVID-19) pandemic significantly influenced antimicrobial prescribing practices worldwide, raising concerns about antimicrobial resistance (AMR). This narrative review assesses the relationship between COVID-19 and antibiotic use, focusing on bacterial co-infections, prescribing patterns, long-term implications for AMR, and the role of multidisciplinary antimicrobial and diagnostic stewardship, preventive strategies, and the One Health approach in reducing disproportionate antibiotic exposure. To this end we ran a subject search across PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, Ovid, and Google Scholar for studies selected according to predefined inclusion and exclusion criteria. Despite relatively low rates of confirmed bacterial co-infections, antibiotic use remained disproportionately high, particularly during the early stages of the pandemic, highlighting challenges in clinical decision-making under diagnostic uncertainty. Excessive and inappropriate antibiotic prescribing may have contributed to the global AMR burden. Strengthening antimicrobial stewardship programmes, improving diagnostic accuracy and promoting evidence-based prescribing are therefore essential. Multidisciplinary antimicrobial stewardship interventions, rapid molecular diagnostics and vaccination-associated reductions in antibiotic prescribing emerge as complementary strategies for limiting unnecessary antimicrobial exposure, while the environmental consequences of antibiotic use further emphasise the relevance of the One Health approach. Continued surveillance and research are needed to better understand the long-term impact of the pandemic on AMR. (© 2026 Marija Špelić et al., published by Institute for Medical Research and Occupational Health.) |
| References: | Front Microbiol. 2021 Oct 11;12:717809. (PMID: 34707579) Antibiotics (Basel). 2021 Mar 15;10(3):. (PMID: 33804087) Heliyon. 2023 Oct 10;9(10):e20563. (PMID: 37876436) BMJ. 2021 Mar 29;372:n71. (PMID: 33782057) JAMA Netw Open. 2021 Sep 1;4(9):e2126114. (PMID: 34550387) MMWR Morb Mortal Wkly Rep. 2021 Jul 23;70(29):1013-1019. (PMID: 34292924) Infect Prev Pract. 2025 Jun 03;7(3):100461. (PMID: 40922939) Eur J Clin Microbiol Infect Dis. 2021 Oct;40(10):2227-2234. (PMID: 33733394) Infect Control Hosp Epidemiol. 2021 Jan;42(1):84-88. (PMID: 32703320) Influenza Other Respir Viruses. 2016 Sep;10(5):394-403. (PMID: 27232677) Lancet Infect Dis. 2023 Jun;23(6):673-682. (PMID: 36716763) BMC Infect Dis. 2023 Jan 9;23(1):14. (PMID: 36624396) Clin Infect Dis. 2021 May 18;72(10):e533-e541. (PMID: 32820807) J Antimicrob Chemother. 2021 Oct 11;76(11):3045-3058. (PMID: 34473285) S Afr Med J. 2015 Apr 06;105(5):325. (PMID: 26242647) PLoS One. 2022 Aug 1;17(8):e0272375. (PMID: 35913964) Fed Pract. 2023 Jun;40(6):178-181a. (PMID: 37860070) Clin Microbiol Infect. 2023 Mar;29(3):302-309. (PMID: 36509377) Antibiotics (Basel). 2020 Nov 17;9(11):. (PMID: 33212785) Infection. 2023 Apr;51(2):331-336. (PMID: 35716341) Sci Total Environ. 2026 Jun 20;1036:181868. (PMID: 42127876) Antimicrob Steward Healthc Epidemiol. 2023 Nov 15;3(1):e208. (PMID: 38156208) Rev Esp Quimioter. 2021 Sep;34 Suppl 1:63-68. (PMID: 34598431) Clin Microbiol Infect. 2020 Dec;26(12):1622-1629. (PMID: 32711058) Lancet Digit Health. 2021 Jun;3(6):e360-e370. (PMID: 34045002) Int J Infect Dis. 2021 Oct;111:322-325. (PMID: 34508864) Anaerobe. 2022 Apr;74:102484. (PMID: 34843959) Antimicrob Resist Infect Control. 2022 Mar 7;11(1):45. (PMID: 35255988) Elife. 2021 Feb 16;10:. (PMID: 33588991) Cureus. 2024 Sep 11;16(9):e69170. (PMID: 39398725) Am J Emerg Med. 2022 Jan;51:1-5. (PMID: 34637995) Clin Infect Dis. 2024 Aug 16;79(2):375-381. (PMID: 38700036) Clin Infect Dis. 2020 Dec 3;71(9):2459-2468. (PMID: 32358954) Clin Microbiol Infect. 2020 Oct;26(10):1395-1399. (PMID: 32603803) Lancet. 2021 Feb 13;397(10274):605-612. (PMID: 33545096) Antibiotics (Basel). 2024 Jun 12;13(6):. (PMID: 38927211) J Multidiscip Healthc. 2022 Nov 09;15:2605-2614. (PMID: 36388623) Lancet. 2022 Apr 16;399(10334):1513-1536. (PMID: 35279232) PLoS One. 2021 May 6;16(5):e0251170. (PMID: 33956882) |
| Contributed Indexing: | Keywords: Jedno zdravlje; One Health; antimicrobial resistance; antimicrobial stewardship; antimikrobna rezistencija; bacterial co-infection; bakterijska koinfekcija; upravljanje upotrebom antibiotika Local Abstract: [Publisher, Croatian] Pandemija koronavirusne bolesti (COVID-19) značajno je utjecala na praksu propisivanja antimikrobnih lijekova širom svijeta, izazivajući zabrinutost zbog antimikrobne rezistencije (AMR). Cilj je ovoga preglednog rada ispitati odnos između bolesti COVID-19 i uporabe antibiotika, s naglaskom na učestalost bakterijskih koinfekcija, obrasce propisivanja i na moguće dugoročne posljedice za AMR. Istaknuta je uloga multidisciplinarnog upravljanja antimikrobnom terapijom, racionalnog upravljanja dijagnostičkim postupcima, preventivnih strategija i pristupa Jednog zdravlja. Pregled literature proveden je pretraživanjem baza PubMed/MEDLINE, Scopus, Web of Science, Cochrane Database of Systematic Reviews, Ovid i Google Scholar, uz unaprijed određene kriterije uključivanja i isključivanja. Unatoč relativno niskim stopama potvrđenih bakterijskih koinfekcija, uporaba antibiotika bila je neproporcionalno visoka, osobito tijekom ranih faza pandemije, što je naglasilo izazove kliničkog odlučivanja u uvjetima dijagnostičke nesigurnosti. Jačanje programa upravljanja antimikrobnom terapijom, poboljšanje dijagnostičke točnosti i propisivanje temeljeno na dokazima ključni su za smanjenje nepotrebne izloženosti antibioticima. Multidisciplinarne AMS intervencije, brza molekularna dijagnostika i smanjenje propisivanja antibiotika povezano s cijepljenjem pokazali su se kao komplementarne strategije, dok su okolišne posljedice primjene antibiotika dodatno istaknule važnost pristupa Jednog zdravlja. Potrebni su kontinuirano praćenje i daljnja istraživanja radi boljeg razumijevanja dugoročnog utjecaja pandemije na AMR. |
| Substance Nomenclature: | 0 (Anti-Bacterial Agents) |
| Entry Date(s): | Date Created: 20261011 Date Completed: 20261011 Latest Revision: 20261016 |
| Update Code: | 20261016 |
| PubMed Central ID: | PMC13613159 |
| DOI: | 10.2478/aiht-2026-77-4130 |
| PMID: | 42859407 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1848-6312 |
|---|---|
| DOI: | 10.2478/aiht-2026-77-4130 |