Antibiotics | Notable Article: How the COVID-19 Pandemic Accelerated Global Carbapenem Resistance Spread

This article systematically reviews the global epidemiological impact of the pandemic on carbapenem resistance, analyzes changes in antibiotic usage patterns, infection control practices, resistance mechanisms, and transmission dynamics. It provides monitoring data from multiple countries, identifies key drivers behind increased resistance during the pandemic, and discusses future response strategies.

 

Literature Overview
This article, 'The Impact of COVID-19 on the Epidemiology of Carbapenem Resistance' published in the Antibiotics journal, reviews and summarizes the pandemic's effects on transmission trends of carbapenem-resistant pathogens including carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA). Research demonstrates that pandemic-induced strains on healthcare resources, antibiotic overuse, and weakened infection control measures led to widespread dissemination of CROs in ICUs and COVID wards, with significant increases in resistance rates. The study also emphasizes the importance of genomic surveillance and environmental resistance gene reservoirs.

Background Knowledge
Carbapenems represent critical therapeutic options for multidrug-resistant Gram-negative bacterial infections, though resistance mechanisms (such as carbapenemases, membrane permeability alterations, and efflux pump overexpression) significantly complicate treatment. During early pandemic stages, extensive empirical use of broad-spectrum antibiotics including carbapenems by clinicians increased selective pressure for resistant strains. Additionally, weakened infection control practices, personal protective equipment (PPE) shortages, and expanded environmental resistance gene reservoirs further accelerated pathogen transmission. This study systematically evaluates the pandemic's impact on global carbapenem resistance trends through multinational monitoring data, genomic analyses, and clinical studies, highlighting the critical importance of antimicrobial stewardship during future public health crises.

 

 

Research Methods and Experiments
This study employs systematic literature review methodologies combined with antimicrobial resistance monitoring data from 2019-2025, WHO reports, and European Centre for Disease Prevention and Control (ECDC) documents to analyze the pandemic's impact on carbapenem resistance epidemiology. Key research areas include healthcare-associated infections, antibiotic usage patterns, changes in infection control practices, and resistance gene transmission dynamics. The authors also evaluate genomic and environmental monitoring data to reveal molecular mechanisms and transmission pathways of carbapenem-resistant pathogens.

Key Conclusions and Perspectives

• Excessive use of broad-spectrum antibiotics (including carbapenems) occurred during the pandemic, particularly in ICU settings without definitive bacterial co-infection evidence.
• Reallocation of healthcare resources, weakened infection control measures, and expanded environmental resistance gene reservoirs synergistically facilitated nosocomial transmission of carbapenem-resistant pathogens.
• Multiple countries reported significant increases in carbapenem-resistant organisms (CRE, CRAB, CRPA), particularly in low-income and middle-income nations.
• Resistance mechanisms demonstrated diversification through synergistic actions between carbapenemases (KPC, NDM, OXA-48) and non-enzymatic mechanisms (reduced membrane permeability, efflux pump overexpression).
• Enhanced biofilm formation capabilities in resistant pathogens enabled persistent colonization and sustained transmission within ICU environments.
• Hospital wastewater monitoring revealed continuous presence of resistance genes (e.g., bla_OXA, bla_NDM) during the pandemic, indicating environmental transmission risks.
• While the pandemic caused short-term disruptions to infection control and antimicrobial management, long-term containment requires strengthened stewardship strategies and enhanced infection control measures.

Research Significance and Prospects
The study emphasizes the necessity of maintaining antimicrobial stewardship and infection control systems during public health emergencies. Future efforts should strengthen global antimicrobial resistance monitoring systems, improve rapid diagnostic capabilities, and integrate digital antimicrobial management with remote infection control strategies. Additionally, novel therapeutic approaches targeting carbapenem-resistant pathogens must be developed to address post-pandemic treatment challenges.

 

 

Conclusion
The COVID-19 pandemic has profoundly influenced global antimicrobial resistance (AMR) trends, particularly through accelerated dissemination of carbapenem-resistant pathogens. Healthcare-associated infections, antimicrobial misuse, weakened infection control measures, and persistent environmental resistance genes collectively drove rapid pathogen spread. Through multinational data analysis and genomic studies, this research reveals dynamic changes in resistance mechanisms including accelerated dissemination of carbapenemase genes (blaKPC, blaNDM, blaOXA-48) and enhanced biofilm formation and efflux pump activities. The study underscores the necessity of prioritizing antimicrobial stewardship and infection control during future public health crises to prevent further resistance escalation. Additionally, low-income countries require strengthened AMR surveillance systems and improved laboratory testing capabilities to address post-pandemic global resistance dissemination trends. This work provides critical reference for future AMR response strategies, particularly regarding multiple pathogen co-infections and environmental resistance gene monitoring.

 

Aikaterini Sakagianni, Christina Koufopoulou, Petros Koufopoulos, Georgios Feretzakis, and Vasiliki Koumaki. The Impact of COVID-19 on the Epidemiology of Carbapenem Resistance. Antibiotics.