Abstract：
OBJECTIVE: The COVID-19 pandemic has posed a significant threat to the global healthcare system, presenting a major challenge to antimicrobial stewardship worldwide. This study aimed to provide a comprehensive and up-to-date picture of global antimicrobial resistance (AMR) and antibiotic use in COVID-19 patients.
METHODS: We conducted a systematic review to determine the prevalence of AMR and antibiotic usage among COVID-19 patients receiving treatment in healthcare facilities. Our search encompassed the PubMed, Web of Science, Embase, and Scopus databases, spanning studies published from December 2019 to May 2023. We utilized random-effects meta-analysis to assess the prevalence of multidrug-resistant organisms (MDROs) and antibiotic use in COVID-19 patients, aligning with both the WHO\'s priority list of MDROs and the AWaRe list of antibiotic products. Estimates were stratified by region, country, and country income. Meta-regression models were established to identify predictors of MDRO prevalence and antibiotic use in COVID-19 patients. The study protocol was registered with PROSPERO (CRD 42023449396).
RESULTS: Among the 11,050 studies screened, 173 were included in the review, encompassing a total of 892,312 COVID-19 patients. MDROs were observed in 42.9% (95% CI 31.1-54.5%, I2 = 99.90%) of COVID-19 patients: 41.0% (95% CI 35.5-46.6%) for carbapenem-resistant organisms (CRO), 19.9% (95% CI 13.4-27.2%) for methicillin-resistant Staphylococcus aureus (MRSA), 24.9% (95% CI 16.7-34.1%) for extended-spectrum beta-lactamase-producing organisms (ESBL), and 22.9% (95% CI 13.0-34.5%) for vancomycin-resistant Enterococcus species (VRE), respectively. Overall, 76.2% (95% CI 69.5-82.9%, I2 = 99.99%) of COVID-19 patients were treated with antibiotics: 29.6% (95% CI 26.0-33.4%) with \"Watch\" antibiotics, 22.4% (95% CI 18.0-26.7%) with \"Reserve\" antibiotics, and 16.5% (95% CI 13.3-19.7%) with \"Access\" antibiotics. The MDRO prevalence and antibiotic use were significantly higher in low- and middle-income countries than in high-income countries, with the lowest proportion of antibiotic use (60.1% (95% CI 52.1-68.0%)) and MDRO prevalence (29.1% (95% CI 21.8-36.4%)) in North America, the highest MDRO prevalence in the Middle East and North Africa (63.9% (95% CI 46.6-81.2%)), and the highest proportion of antibiotic use in South Asia (92.7% (95% CI 90.4-95.0%)). The meta-regression identified antibiotic use and ICU admission as a significant predictor of higher prevalence of MDROs in COVID-19 patients.
CONCLUSIONS: This systematic review offers a comprehensive and current assessment of MDRO prevalence and antibiotic use among COVID-19 patients in healthcare facilities. It underscores the formidable challenge facing global efforts to prevent and control AMR amidst the backdrop of the COVID-19 pandemic. These findings serve as a crucial warning to policymakers, highlighting the urgent need to enhance antimicrobial stewardship strategies to mitigate the risks associated with future pandemics.
METHODS: We conducted a systematic review to determine the prevalence of AMR and antibiotic usage among COVID-19 patients receiving treatment in healthcare facilities. Our search encompassed the PubMed, Web of Science, Embase, and Scopus databases, spanning studies published from December 2019 to May 2023. We utilized random-effects meta-analysis to assess the prevalence of multidrug-resistant organisms (MDROs) and antibiotic use in COVID-19 patients, aligning with both the WHO\'s priority list of MDROs and the AWaRe list of antibiotic products. Estimates were stratified by region, country, and country income. Meta-regression models were established to identify predictors of MDRO prevalence and antibiotic use in COVID-19 patients. The study protocol was registered with PROSPERO (CRD 42023449396).
RESULTS: Among the 11,050 studies screened, 173 were included in the review, encompassing a total of 892,312 COVID-19 patients. MDROs were observed in 42.9% (95% CI 31.1-54.5%, I2 = 99.90%) of COVID-19 patients: 41.0% (95% CI 35.5-46.6%) for carbapenem-resistant organisms (CRO), 19.9% (95% CI 13.4-27.2%) for methicillin-resistant Staphylococcus aureus (MRSA), 24.9% (95% CI 16.7-34.1%) for extended-spectrum beta-lactamase-producing organisms (ESBL), and 22.9% (95% CI 13.0-34.5%) for vancomycin-resistant Enterococcus species (VRE), respectively. Overall, 76.2% (95% CI 69.5-82.9%, I2 = 99.99%) of COVID-19 patients were treated with antibiotics: 29.6% (95% CI 26.0-33.4%) with \"Watch\" antibiotics, 22.4% (95% CI 18.0-26.7%) with \"Reserve\" antibiotics, and 16.5% (95% CI 13.3-19.7%) with \"Access\" antibiotics. The MDRO prevalence and antibiotic use were significantly higher in low- and middle-income countries than in high-income countries, with the lowest proportion of antibiotic use (60.1% (95% CI 52.1-68.0%)) and MDRO prevalence (29.1% (95% CI 21.8-36.4%)) in North America, the highest MDRO prevalence in the Middle East and North Africa (63.9% (95% CI 46.6-81.2%)), and the highest proportion of antibiotic use in South Asia (92.7% (95% CI 90.4-95.0%)). The meta-regression identified antibiotic use and ICU admission as a significant predictor of higher prevalence of MDROs in COVID-19 patients.
CONCLUSIONS: This systematic review offers a comprehensive and current assessment of MDRO prevalence and antibiotic use among COVID-19 patients in healthcare facilities. It underscores the formidable challenge facing global efforts to prevent and control AMR amidst the backdrop of the COVID-19 pandemic. These findings serve as a crucial warning to policymakers, highlighting the urgent need to enhance antimicrobial stewardship strategies to mitigate the risks associated with future pandemics.
摘要：
目标：COVID-19大流行对全球医疗保健系统构成了重大威胁，对全球抗菌药物管理提出了重大挑战。
方法：我们进行了系统评价，以确定在医疗机构接受治疗的COVID-19患者的抗菌素耐药性（AMR）患病率和抗生素使用情况。我们的搜索包括PubMed，WebofScience,Embase,和Scopus数据库，2019年12月至2023年5月发表的跨期研究。我们利用随机效应荟萃分析来评估COVID-19患者的多药耐药菌（MDROs）和抗生素使用情况，与WHO的MDRO优先清单和AWARE抗生素产品清单保持一致。估计按地区分层，国家,国家收入。建立Meta回归模型以确定COVID-19患者MDRO患病率和抗生素使用的预测因素。研究方案在PROSPERO(CRD42023449396)注册。
结果：在筛选的11,050项研究中，173人被纳入审查，共892,312例COVID-19患者。在42.9%(95%CI31.1%-54.5%，I2=99.90%)的COVID-19患者：碳青霉烯耐药生物(CRO)占41.0%(95%CI35.5%-46.6%)，耐甲氧西林金黄色葡萄球菌（MRSA）占19.9%（95%CI13.4%-27.2%），产超广谱β-内酰胺酶生物（ESBL）的24.9%（95%CI16.7%-34.1%），耐万古霉素肠球菌属（VRE）为22.9%（95%CI13.0%-34.5%），分别。总的来说,76.2%（95%CI69.5%-82.9%，I2=99.99%）的COVID-19患者接受了抗生素治疗：29.6%（95%CI26.0%-33.4%）接受了“观察”抗生素治疗，22.4%（95%CI18.0%-26.7%）使用“储备”抗生素，16.5%（95%可信区间13.3%-19.7%）使用“访问”抗生素。中低收入国家的MDRO患病率和抗生素使用明显高于高收入国家，在北美，抗生素使用比例最低（60.1%（95%CI52.1%-68.0%））和MDRO患病率最低（29.1%（95%CI21.8%-36.4%）），中东和非洲MDRO患病率最高(63.9%(95%CI46.6%-81.2%))，南亚抗生素使用比例最高(92.7%(95%CI90.4%-95.0%))。荟萃回归将抗生素使用和ICU入住确定为COVID-19患者中MDROs患病率较高的重要预测因子。
结论：本系统评价对医疗机构中COVID-19患者的MDRO患病率和抗生素使用情况进行了全面和最新的评估。它强调了在COVID-19大流行的背景下，全球预防和控制AMR的努力面临的巨大挑战。这些发现对决策者来说是一个至关重要的警告，强调迫切需要加强抗菌药物管理战略，以减轻与未来大流行相关的风险。
方法：我们进行了系统评价，以确定在医疗机构接受治疗的COVID-19患者的抗菌素耐药性（AMR）患病率和抗生素使用情况。我们的搜索包括PubMed，WebofScience,Embase,和Scopus数据库，2019年12月至2023年5月发表的跨期研究。我们利用随机效应荟萃分析来评估COVID-19患者的多药耐药菌（MDROs）和抗生素使用情况，与WHO的MDRO优先清单和AWARE抗生素产品清单保持一致。估计按地区分层，国家,国家收入。建立Meta回归模型以确定COVID-19患者MDRO患病率和抗生素使用的预测因素。研究方案在PROSPERO(CRD42023449396)注册。
结果：在筛选的11,050项研究中，173人被纳入审查，共892,312例COVID-19患者。在42.9%(95%CI31.1%-54.5%，I2=99.90%)的COVID-19患者：碳青霉烯耐药生物(CRO)占41.0%(95%CI35.5%-46.6%)，耐甲氧西林金黄色葡萄球菌（MRSA）占19.9%（95%CI13.4%-27.2%），产超广谱β-内酰胺酶生物（ESBL）的24.9%（95%CI16.7%-34.1%），耐万古霉素肠球菌属（VRE）为22.9%（95%CI13.0%-34.5%），分别。总的来说,76.2%（95%CI69.5%-82.9%，I2=99.99%）的COVID-19患者接受了抗生素治疗：29.6%（95%CI26.0%-33.4%）接受了“观察”抗生素治疗，22.4%（95%CI18.0%-26.7%）使用“储备”抗生素，16.5%（95%可信区间13.3%-19.7%）使用“访问”抗生素。中低收入国家的MDRO患病率和抗生素使用明显高于高收入国家，在北美，抗生素使用比例最低（60.1%（95%CI52.1%-68.0%））和MDRO患病率最低（29.1%（95%CI21.8%-36.4%）），中东和非洲MDRO患病率最高(63.9%(95%CI46.6%-81.2%))，南亚抗生素使用比例最高(92.7%(95%CI90.4%-95.0%))。荟萃回归将抗生素使用和ICU入住确定为COVID-19患者中MDROs患病率较高的重要预测因子。
结论：本系统评价对医疗机构中COVID-19患者的MDRO患病率和抗生素使用情况进行了全面和最新的评估。它强调了在COVID-19大流行的背景下，全球预防和控制AMR的努力面临的巨大挑战。这些发现对决策者来说是一个至关重要的警告，强调迫切需要加强抗菌药物管理战略，以减轻与未来大流行相关的风险。
