Changes in antibiotic resistance before and during the COVID-19 pandemic: Laboratory surveillance study in a single Indonesian tertiary hospital

Background: Antibiotic resistance is related to inappropriate empiric antibiotics, particularly during the COVID-19 pandemic. Limited information about changes in antibiotic resistance before and during the pandemic in Indonesia. This study aimed to describe changes in the prevalence of antibiotic resistance among patients with proven bacterial infections before and during the COVID-19 pandemic. Methods: A retrospective surveillance study was carried out to review culture and antibiotic susceptibility data among hospitalized patients diagnosed with sepsis and COVID-19 according to the ICD-10. In this context, the predefined periods were 1 January–31 December 2019 and 1 March 2020–31 December 2021. The result was the percentage of resistance to selected antibiotics among the study population, stratified by gram-bacterial isolates type, with the evaluation of changes in antibiotic resistance over time. Results: In this study, 596 adult patients were diagnosed with sepsis (before COVID-19), and 2786 were diagnosed with confirmed COVID-19 (during COVID-19). The rate of culture growth in patients with sepsis and COVID-19, with values of 51.6% and 29.2%, respectively. Gram-negative bacterial isolates were predominantly found in all observation periods, 41.2% - 47.3% of the adult middle-aged group. Changes in antibiotic resistance against Gram-negative bacteria were observed during COVID-19 (peak phase, above 20%) compared to the early phase. Conclusions: This study revealed that changes in antibiotic resistance before and during the COVID-19 pandemic affected both Gram-negative and Gram-positive bacteria. Therefore, implementing surveillance systems and antimicrobial stewardship programs are recommended for combatting antibiotic resistance.