Epidemiology of Escherichia coli bloodstream infection antimicrobial resistance trends across South West England during the first 2 years of the coronavirus disease 2019 pandemic response

Jack Stanley; Brian Sullivan; Andrew W Dowsey; Koren Jones; Charles R Beck

doi:10.1016/j.cmi.2024.03.018

Epidemiology of Escherichia coli bloodstream infection antimicrobial resistance trends across South West England during the first 2 years of the coronavirus disease 2019 pandemic response

Clin Microbiol Infect. 2024 Mar 23:S1198-743X(24)00148-4. doi: 10.1016/j.cmi.2024.03.018. Online ahead of print.

Authors

Jack Stanley¹, Brian Sullivan¹, Andrew W Dowsey¹, Koren Jones², Charles R Beck³

Affiliations

¹ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
² Evaluation & Epidemiological Science Division, Science Group, UK Health Security Agency, Porton Down, UK; Field Services South West, Health Protection Operations, UK Health Security Agency, Bristol, UK.
³ Evaluation & Epidemiological Science Division, Science Group, UK Health Security Agency, Porton Down, UK; Field Services South West, Health Protection Operations, UK Health Security Agency, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK. Electronic address: charles.beck@ukhsa.gov.uk.

PMID: 38527612
DOI: 10.1016/j.cmi.2024.03.018

Abstract

Objectives: Between 2016 and 2019, 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 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.

Methods: We undertook a retrospective ecological analysis utilizing routine surveillance data of E. coli BSI cases reported to the UK Health Security Agency between 2016 and 2021. We analysed AMR trends for antimicrobial agents including amoxicillin-clavulanate, ciprofloxacin, piperacillin-tazobactam, gentamicin, third-generation cephalosporins and carbapenems before and after the implementation of COVID-19 restrictions (23 March 2020) using Bayesian segmented regression.

Results: We identified 19 055 cases. A total of 50.2% were male. Median age was 76 (interquartile range, 65-85 years). 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 the 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 after the implementation of COVID-19 restrictions, with moderate evidence for a lower OR after restrictions as compared to the period before (gentamicin Bayes Factor = 5.10, third-generation cephalosporins Bayes Factor = 6.67).

Discussion: COVID-19 restrictions led to abrupt and longer term changes to E.coli BSI AMR. The immediate effects suggest altered transmission, whereas changes to resistant E. coli reservoirs may explain trend effects.

Keywords: Antimicrobial resistance; COVID-19; Epidemiology; Escherichia coli; Gram negative; Non-pharmaceutical intervention.