The impact of the COVID-19 pandemic on the antibiotic consumption and resistance in Montenegro

Montenegro has been at the top of the European antibiotic (AB) consumption list for a decade. Also, the invasive isolates of significant Gram "-" pathogens have one of the highest rates of resistance to key AB in Europe. A COVID-19 pandemic announced in 2020 had a significant impact on AB consumption globally. We analysed the consumption of AB in the pre-COVID (2019) and COVID-19 pandemic (2020, 2021, and 2022) period, and compared it with data on the resistance of Gram "-" invasive isolates of important pathogens to key AB. Data on total AB consumption in Montenegro (2011-2022) show that the growth rate in 2021 compared to 2020 was 14.04%, which is a statistically significantly higher value compared to previous years (P < .005, Z-value = 7.43). Additionally, there was a change in the structure of AB consumed, including hospital AB. Resistance of Escherichia coli to the third generation of cephalosporins increased significantly from 38% (9/24) in 2019 to 67% (16/24) in the COVID (2022) year (χ2 = 4.0904, P < .05). The highest rate of Klebsiella pneumoniae resistance to carbapenems was recorded in 2022, 47% (18/38), and was significantly higher compared to 2019 (17% (4/23)) (χ2 = 5.5838, P < .05). The rate of resistance to macrolides of Staphylococcus aureus strains increased significantly from 11% (101/920) in 2019 to 18% (134/735) in 2022 (χ2 = 17 640; P < .001). COVID-19 pandemic altered the resistance map of important pathogens to key antibiotics in Montenegro. A complete national stewardship program must be developed, and the surveillance should be rigorously enhanced and maintained.