Changes in antimicrobial resistance of Escherichia coli isolated from community-associated urinary tract infection before and during the COVID-19 pandemic in India

Impact of COVID-19 pandemic on antimicrobial resistance (AMR) is largely studied in healthcare settings, there is a need to understand the fluctuations in AMR during pandemic at the community level. Urinary tract infection (UTI) being one of the most common infections in the community, AMR profile of Community-acquired UTI (CA-UTI) is considered representative AMR at the community level. The study was taken in cohort of patients with clinical diagnosis of CA-UTI. The four study sites represented different community health centres in India. Escherichia coli (E. coli) isolates were analysed phenotypically and genotypically for AMR during Pre-COVID (Oct 2019- Feb 2020), 1st wave (Mar 2020 – Feb 2021) and 2nd wave of COVID-19 (Mar 2021- Dec 2021). E. coli was the predominant uropathogen (229, 82%). Increased susceptibility to nitrofurantoin was observed during pandemic. Reduced susceptibility to first line oral antibiotics and carbapenems was seen during 2nd wave. Increased MIC50 to beta-lactams and fluoroquinolones was seen during pandemic. Genomic analysis of E. coli isolates showed some AMR genes aacC1, aacC4, SHV, QepA only during 2nd wave. The good impact of pandemic was evidenced by increased susceptibility to nitrofurantoin. The significant decrease in susceptibility to oral antibiotics during 2nd wave and increased MIC50 of few antibiotics are the bad impact. Decreased susceptibility to last-resort carbapenems and occurrence of various AMR genes only during 2nd wave of pandemic are of great concern and are the ugly impact of pandemic on AMR.