ABSTRACT
BackgroundCOVID-19 and antimicrobial resistance (AMR) are two intersecting global public health crises. ObjectiveWe aim to describe the impact of the COVID-19 pandemic on AMR across healthcare settings. Data SourceA search was conducted in December 2021 in World Health Organizations COVID-19 Research Database with forward citation searching up to June 2022. Study EligibilityStudies evaluating the impact of COVID-19 on AMR in any population were included and influencing factors were extracted. MethodsPooling was done separately for Gram-negative and Gram-positive organisms. Random effects meta-analysis was performed. ResultsOf 6036 studies screened, 28 were included and 23 provided sufficient data for meta-analysis. The majority of studies focused on hospital settings (n=25, 89%). The COVID-19 pandemic was not associated with a change in the incidence density (IRR 0.99, 95% CI: 0.67 to 1.47) or proportion (RR 0.91, 95% CI: 0.55 to 1.49) of MRSA or VRE cases. A non-statistically significant increase was noted for resistant Gram-negatives (i.e., ESBL, CRE, MDR or carbapenem-resistant Pseudomonas or Acinetobacter species, IRR 1.64, 95% CI: 0.92 to 2.92; RR 1.08, 95% CI: 0.91 to 1.29). The absence of enhanced IPAC and/or ASP initiatives was associated with an increase in Gram-negative AMR (RR 1.11, 95%CI: 1.03 to 1.20), while studies that did report implementation of these initiatives noted no change in Gram-negative AMR (RR 0.80, 95%CI: 0.38 to 1.70). However, a test for subgroup differences showed no statistically significant difference between these groups (P=0.40) ConclusionThe COVID-19 pandemic could play an important role in the emergence and transmission of AMR, particularly for Gram-negative organisms in hospital settings. There is considerable heterogeneity in both the AMR metrics utilized and the rate of resistance reported across studies. These findings reinforce the need for strengthened infection prevention, antimicrobial stewardship, and AMR surveillance in the context of the COVID-19 pandemic. PROSPERO registration: CRD42022325831This research was carried out as part of routine work, no funding was received Data collection template, data, and analytic code are available upon request.
Subject(s)
COVID-19ABSTRACT
BackgroundWhilst timely clinical characterisation of infections caused by novel SARS-CoV-2 variants is necessary for evidence-based policy response, individual-level data on infecting variants are typically only available for a minority of patients and settings. MethodsHere, we propose an innovative approach to study changes in COVID-19 hospital presentation and outcomes after the Omicron variant emergence using publicly available population-level data on variant relative frequency to infer SARS-CoV-2 variants likely responsible for clinical cases. We apply this method to data collected by a large international clinical consortium before and after the emergence of the Omicron variant in different countries. ResultsOur analysis, that includes more than 100,000 patients from 28 countries, suggests that in many settings patients hospitalised with Omicron variant infection less often presented with commonly reported symptoms compared to patients infected with pre-Omicron variants. Patients with COVID-19 admitted to hospital after Omicron variant emergence had lower mortality compared to patients admitted during the period when Omicron variant was responsible for only a minority of infections (odds ratio in a mixed-effects logistic regression adjusted for likely confounders, 0.67 [95% confidence interval 0.61 - 0.75]). Qualitatively similar findings were observed in sensitivity analyses with different assumptions on population-level Omicron variant relative frequencies, and in analyses using available individual-level data on infecting variant for a subset of the study population. ConclusionsAlthough clinical studies with matching viral genomic information should remain a priority, our approach combining publicly available data on variant frequency and a multi-country clinical characterisation dataset with more than 100,000 records allowed analysis of data from a wide range of settings and novel insights on real-world heterogeneity of COVID-19 presentation and clinical outcome.
Subject(s)
COVID-19ABSTRACT
Background: Evidence on the association between HIV infection and the risk of poor clinical outcomes in people with COVID-19 remains inconclusive. The World Health Organization (WHO) has established a Global Clinical Platform aimed to assess clinical features and risk factors for severe/fatal COVID-19 among individuals hospitalized with suspected or confirmed SARS-CoV-2 infection.Methods: Between January 2020-June 2021 anonymized individual-level clinical data from 338,566 patients hospitalized in 38 countries were reported to the WHO Clinical Platform using a standardized set of variables including demographics, vital signs, underlying conditions, laboratory values, therapeutics and medical care received, and clinical outcomes. Descriptive and regression analyses whether HIV status was a risk factor for severity at admission and in-hospital mortality among people hospitalized for COVID-19.Findings: Of 197,479 patients reporting HIV status, 8.6% (16,955) were living with HIV (PLHIV), and 94.6% (16,283) were from Africa. Among those, 37.1% were male, mean age was 45.5 years, 38.3% were admitted with severe or critical illness and 24.7% died in-hospital. Among 10,166 individuals with information about antiretroviral therapy (ART) status, 91.5% were on ART. When compared to those without HIV, PLHIV had 15% increased odds of severe/critical presentation (aOR=1.15, 95%CI 1.10–1.20) and 38% more likely to die in-hospital (aHR=1.38, 95%CI 1.34-1.41). Among PLHIV, being male, age 45-75 years, having chronic cardiac disease or hypertension increased the odds of severe/critical COVID-19; male sex, age>18 years, having diabetes, hypertension, malignancy, TB, or chronic kidney disease increased the risk of in-hospital mortality.Interpretation: In this sample of hospitalized people contributing data to the WHO Global Clinical Platform for COVID-19, HIV was a significant independent risk factor for both severe/critical COVID-19 at admission and in-hospital mortality. These findings have informed the WHO COVID-19 Clinical Management Guidelines and SAGE recommendations around COVID-19 vaccination prioritization among vulnerable groups.Funding Information: None.Declaration of Interests: R.H. received funding from the Wellcome Trust, CIHR UKRI/MRC and ICODA. None of the other authors have any conflicts of interest to disclose.Ethics Approval Statement: The analysis plan25 was submitted to the WHO Ethical Review Committee which granted a waiver from ethical review clearance as this was passive, anonymized clinical surveillance. Ethical clearance was obtained, where necessary, by relevant institutional or national bodies.