Impact of the COVID-19 pandemic on the surveillance of antimicrobial resistance

J Hosp Infect. 2021 Nov:117:147-156. doi: 10.1016/j.jhin.2021.09.011. Epub 2021 Sep 22.


Background: The impact of the coronavirus disease (COVID-19) pandemic on antimicrobial resistance (AMR) is a major concern.

Aim: To compare the number of patients and isolation rate of antimicrobial-resistant bacteria before and after the beginning of the COVID-19 pandemic using the comprehensive national surveillance data.

Methods: We utilized comprehensive surveillance data, collected in the Japan Nosocomial Infections Surveillance programme, which included a total of 16.7 million samples of 5.9 million tested patients from >1300 hospitals. We compared the number of patients and isolation rate of five bacteria between 2019 and 2020, including antimicrobial-susceptible and -resistant bacteria of Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.

Findings: The number of patients and isolation rate of S. aureus and meticillin-resistant S. aureus decreased slightly; those of S. pneumoniae and penicillin-resistant S. pneumoniae decreased by 60%; and those of third-generation cephalosporin-resistant K. pneumoniae increased. The isolation rate of the remaining bacteria apparently increased, although the number of patients decreased. This was due to a substantial decrease in the total number of tested patients (the denominator of the isolation rate), which was larger than that of the number of patients (the numerator of the isolation rate). Consistent results were obtained when the same data were re-aggregated using the procedure of the World Health Organization Global Antimicrobial Resistance Surveillance System, demonstrating the general importance of this problem.

Conclusion: Surveillance data during the COVID-19 pandemic must be carefully interpreted based on examination of the numerator, denominator and background factors that affect the denominator.

Keywords: Antimicrobial resistance; COVID-19; Surveillance; WHO-GLASS.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Infective Agents* / pharmacology
  • COVID-19*
  • Drug Resistance, Bacterial
  • Humans
  • Methicillin-Resistant Staphylococcus aureus*
  • Microbial Sensitivity Tests
  • Pandemics
  • SARS-CoV-2
  • Staphylococcus aureus


  • Anti-Bacterial Agents
  • Anti-Infective Agents