Abstract Objectives The COVID-19 pandemic impacted healthcare use, with mixed reports regarding impacts on antimicrobial resistance. The aim was to identify changes in healthcare utilisation and antibiotic prescribing related to the COVID-19 pandemic and quantify subsequent impacts on antibiotic resistance in clinical Escherichia coli isolates in Scotland. Methods Data involving ∼490 000 people from January 2018 to March 2022 were analysed. Joinpoint regression analyses identified trend changes in healthcare encounters, and antibiotic use in community and hospital settings. Using these joinpoints as an ‘intervention’ timepoint, interrupted time series analysis quantified associated changes in proportions of E. coli blood and urine culture isolates that were antibiotic resistant and multidrug resistant (MDR). Results January 2020 was identified as the intervention point. From 26% resistant (not MDR) and 35% MDR among urine E. coli isolates immediately pre-intervention, there were changes in level of +2.5% (95%CI −0.4% to 5.4%) and trend of +0.3% (95%CI 0.1% to 0.5%) per month for resistant (not MDR), and level change of +0.4% (95%CI −2.0% to 2.8%) but trend change of −0.3% (95%CI −0.5% to −0.1%) per month for MDR. By 9 month post-intervention, compared with predicted levels without intervention, resistant (not MDR) proportions increased while MDR proportions decreased. Similar changes occurred among blood culture isolates, but with less certainty around estimates. Conclusion Small but significant reductions in MDR E. coli resulted from COVID-19-related changes in healthcare and antibiotic use. The findings are critical for antimicrobial stewardship and infection control interventions and evaluation.
Ciaccio et al. (Thu,) studied this question.