Increased antimicrobial resistance during the COVID-19 pandemic

Int J Antimicrob Agents. 2021 Apr;57(4):106324. doi: 10.1016/j.ijantimicag.2021.106324. Epub 2021 Mar 19.


In addition to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection itself, an increase in the incidence of antimicrobial resistance poses collateral damage to the current status of the COVID-19 (coronavirus disease 2019) pandemic. There has been a rapid increase in multidrug-resistant organisms (MDROs), including extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae, carbapenem-resistant New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), pan-echinocandin-resistant Candida glabrata and multi-triazole-resistant Aspergillus fumigatus. The cause is multifactorial and is particularly related to high rates of antimicrobial agent utilisation in COVID-19 patients with a relatively low rate of co- or secondary infection. Appropriate prescription and optimised use of antimicrobials according to the principles of antimicrobial stewardship as well as quality diagnosis and aggressive infection control measures may help prevent the occurrence of MDROs during this pandemic.

Keywords: Antibiotic usage; Antimicrobial resistance; COVID-19; Multidrug-resistant organism.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship
  • Bacteria / drug effects
  • Bacterial Infections / complications*
  • Bacterial Infections / drug therapy
  • Bacterial Infections / epidemiology
  • COVID-19 / complications*
  • COVID-19 / epidemiology*
  • Coinfection / drug therapy*
  • Coinfection / epidemiology
  • Drug Resistance, Microbial*
  • Drug Utilization
  • Fungi / drug effects
  • Humans
  • Incidence
  • Mycoses / complications*
  • Mycoses / drug therapy
  • Mycoses / epidemiology
  • Pandemics


  • Anti-Bacterial Agents