key: cord-1006283-o9y4r4fw
authors: Hirabayashi, Aki; Kajihara, Toshiki; Yahara, Koji; Shibayama, Keigo; Sugai, Motoyuki
title: Impact of the COVID-19 pandemic on the surveillance of antimicrobial resistance
date: 2021-09-22
journal: J Hosp Infect
DOI: 10.1016/j.jhin.2021.09.011
sha: da05c79f4135c269e6829ff8f438874ffe648ddf
doc_id: 1006283
cord_uid: o9y4r4fw

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 program, which included a total of 16.7 million samples of 5.9 million tested patients from >1,300 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 methicillin-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.

, on the left. The number of 152 patients from whom S. aureus or S. pneumoniae were isolated (red and pink in Figure 1 , species (E. coli, K. pneumoniae, and P. aeruginosa) decreased by 7.3%, 7.6%, and 7.2%, 163 in the second quarter, respectively, and decreased by 1.6%, 3.2%, and 3.6%, between 164 the third quarter of 2019 and 2020, respectively. 

aureus, E. coli, and K. pneumoniae isolated from blood, and K. pneumoniae isolated 242 from urine. These results were almost consistent with those from JANIS [9] , as shown 243 in Figure 2 . 

Multi-drug-resistant infections in the COVID-19 era: a 425 framework for considering the potential impact

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The effect of improved hand hygiene on nosocomial

Close proximity

The 491 Transmissibility of Antibiotic-Resistant Enterobacteriaceae in Intensive Care Units

Biofilm formation by ESBL-producing 494 strains of Escherichia coli and Klebsiella pneumoniae

European recommendations for antimicrobial resistance surveillance

Sepsis trends: increasing incidence and decreasing mortality, or changing 500 denominator?

Surveillance for antimicrobial resistant organisms: potential

Laboratory-based surveillance of