The interface between COVID-19 and bacterial healthcare-associated infections

Clin Microbiol Infect. 2021 Dec;27(12):1772-1776. doi: 10.1016/j.cmi.2021.06.001. Epub 2021 Jun 7.


Background: A wide range of bacterial infections occur in coronavirus disease 2019 (COVID-19) patients, particularly in those with severe coronaviral disease. Some of these are community-acquired co-infections.

Objective: To review recent data that indicate the occurrence of hospital-onset bacterial infections, including with antibiotic-resistant isolates, in COVID-19 patients.

Sources: Using PubMed, the literature was searched using terms including: 'COVID-19'; 'SARS-CoV-2'; 'bacterial infection'; 'healthcare-associated infection'; 'antibiotic resistance'; 'antimicrobial resistance'; 'multi-drug resistance'; 'Streptococcus'; 'Staphylococcus'; 'Pseudomonas'; 'Escherichia'; 'Klebsiella'; 'Enterococcus'; 'Acinetobacter'; 'Haemophilus'; 'MRSA'; 'VRE'; 'ESBL'; 'NDM-CRE'; 'CR-Ab'; 'VRSA'; 'MDR'.

Content: There is a growing number of reports of bacterial infections acquired by patients with severe COVID-19 after hospital admission. Antibiotic-resistant pathogens found to cause healthcare-associated infections (HAIs) in COVID-19 patients include methicillin-resistant Staphylococcus aureus, New Delhi metallo-β-lactamase-producing carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, extended-spectrum β-lactamase Klebsiella pneumoniae and vancomycin-resistant enterococci. COVID-19 has impacted bacterial HAIs in a number of ways with an increase in the incidence of New Delhi metallo-β-lactamase-producing carbapenem-resistant Enterobacterales and carbapenem-resistant A. baumannii reported at some hospital sites compared with before the pandemic. Recommended guidelines for antimicrobial stewardship in COVID-19 patient treatment are discussed regarding minimization of empiric broad-spectrum antibiotic use. Other studies have reported a decrease in methicillin-resistant S. aureus and vancomycin-resistant enterococci cases, which has been attributed to enhanced infection prevention and control practices introduced to minimize intra-hospital spread of COVID-19.

Implications: Poorer outcomes have been observed in hospitalized COVID-19 patients with an antibiotic-resistant infection. Although heightened IPC measures have been accompanied by a reduction in some HAIs at specific sites, in other situations, COVID-19 has been associated with an increase in bacterial HAI incidence. Further research is needed to define the cost-benefit relationship of maintaining COVID-19-related infection prevention and control protocols beyond the pandemic to reduce the burden of HAIs. In addition, the longer-term impact of high usage of certain broad-spectrum antibiotics during the COVID-19 pandemic requires evaluation.

Keywords: Antibiotic resistance; Carbapenem-resistant Acinetobacter baumannii; Extended-spectrum β-lactamase; Health-care-associated infection; Methicillin-resistant Staphylococcus aureus; New Delhi metallo-β-lactamase-producing carbapenem-resistant enterobacterales; Severe acute respiratory syndrome coronavirus 2; Vancomycin-resistant enterococcus.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / drug effects
  • Bacterial Infections* / drug therapy
  • Bacterial Infections* / epidemiology
  • COVID-19* / epidemiology
  • Carbapenems
  • Community-Acquired Infections* / drug therapy
  • Community-Acquired Infections* / epidemiology
  • Cross Infection* / drug therapy
  • Cross Infection* / epidemiology
  • Delivery of Health Care
  • Drug Resistance, Bacterial
  • Humans
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Pandemics


  • Anti-Bacterial Agents
  • Carbapenems