Epidemiology of Escherichia coli bloodstream infection antimicrobial resistance trends across South West England during the first two years of the coronavirus disease 2019 pandemic response.

Publication date: Mar 23, 2024

Between 2016-19, the proportion of Escherichia coli bloodstream infection (BSI) with resistance to at least one antibiotic increased nationally. Public health interventions implemented in response to the coronavirus disease 2019 (COVID-19) pandemic changed population contact patterns and healthcare systems, with consequent effects on epidemiological trends of numerous pathogens. We investigated the impact of COVID-19 restrictions on epidemiological trends of E. coli BSI antimicrobial resistance (AMR) across South West England. We undertook a retrospective ecological analysis utilising routine surveillance data of E. coli BSI cases reported to the UK Health Security Agency between 2016-2021. We analysed AMR trends for antimicrobial agents including amoxicillin-clavulanate, ciprofloxacin, piperacillin-tazobactam, gentamicin, third-generation cephalosporins and carbapenems before and after implementation of COVID-19 restrictions (23/03/2020) using Bayesian segmented regression. We identified 19,055 cases. 50. 2% were male. Median age was 76 (interquartile range 65-85). Piperacillin-tazobactam (-2. 90% [95% Highest Density Interval (HDI) -4. 51%, -0. 48%]) and ciprofloxacin (-2. 40% [95% HDI -4. 35%, 0. 48%]) resistance demonstrated immediate step changes at implementation of COVID-19 restrictions. Gentamicin (Odds Ratio (OR) 0. 92 [95% HDI 0. 76, 1. 12]) and third-generation cephalosporins (OR 0. 95 [95% HDI 0. 80, 1. 14]) exhibited decreasing annual resistance trends following implementation of COVID-19 restrictions, with moderate evidence for a lower OR after restrictions as compared to the period before (gentamicin Bayes Factor (BF)=5. 10, third-generation cephalosporins BF=6. 67). COVID-19 restrictions led to abrupt and longer-term changes to E. coli BSI AMR. The immediate effects suggest altered transmission, while changes to resistant E. coli reservoirs may explain trend effects.

Concepts Keywords
Antibiotic Amr
Cephalosporins Antimicrobial
Coronavirus Bloodstream


Type Source Name
disease MESH bloodstream infection
disease MESH coronavirus disease 2019
disease VO population
drug DRUGBANK Amoxicillin
drug DRUGBANK Clavulanic acid
drug DRUGBANK Ciprofloxacin
drug DRUGBANK Piperacillin
drug DRUGBANK Tazobactam
drug DRUGBANK Gentamicin
disease MESH Long Covid

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