The Impact of COVID-19 on Antibiotic Resistance and Clinical Outcomes among Critically Ill Patients

There is conflicting evidence regarding the impact of the Coronavirus 2019 (COVID-19) pandemic on antimicrobial resistance, with few studies conducted in low- and middle-income countries. We investigated the impact of the COVID-19 pandemic on multidrug resistant organisms (MDROs) among critically ill patients and their clinical outcomes.This was a retrospective observational study of patients admitted to the medical Intensive Care Unit (ICU) at Jordan University Hospital and had blood, urine or bronchoalveolar bacterial cultures taken during two time periods: pre-pandemic (i.e., 1/2016 to 1/2019) and pandemic (i.e., 1/2020 to 1/2023). We compared the clinical outcomes (i.e., in-hospital deaths, the need for O2 devices, intubation, the length of hospital stay and the occurrence of complications) and prevalence of MDROs between the two periods and conducted multivariate analyses.There were 1,254 patients (479 pre-pandemic and 775 post-pandemic. The percentage of patients who had MDROs was significantly higher among patients with a culture taken during the pandemic (82.4%) compared to before it (17.6%) (P-value=0.000). Multivariate analysis demonstrated that patients cultured during the pandemic were more than 3 times as likely to have a MDRO (OR=3.210; 95%CI: 2.236-4.609).The increase in MDROs during the COVID-19 pandemic is an alarming threat to public health; thus, investigating the antibiotic resistance situation as the pandemic subsides is crucial.