COVID-19 impact on AMR: a rapid scoping review, equity analysis and evidence gap map study

INTRODUCTION: The COVID-19 pandemic is expected to have impacted many drivers of antimicrobial resistance (AMR) and compounded existing societal and health inequities. This rapid scoping review examined how three selected healthcare system factors, which we have called 'drivers'-antimicrobial use, infection prevention and control and health system use-were affected by COVID-19 and how they have impacted resistance. METHODS: Peer-reviewed searches were performed in MEDLINE, Embase and Cochrane on 19 December 2022 and updated on 25 February 2023 and 1 September 2023. Results of these searches were integrated with an initial search run on 19 October 2022, using the WHO COVID-19 Research Database. References of included studies were also searched to identify any additional relevant studies. Data on the three drivers from included studies were assessed to determine whether they influenced the emergence, spread or number of resistant infections due to antimicrobial-resistant organisms. Studies were then mapped to identify literature gaps and assessed for equity considerations and quality of evidence. RESULTS: 63 studies were analysed. Reported COVID-19 changes to antimicrobial use were associated with increased AMR burden in hospital settings. Conversely, the infection prevention and control measures implemented to reduce COVID spread may have decreased resistance in community settings. Differences in health system use during the COVID-19 pandemic may have increased resistance, although we identified knowledge gaps on COVID-19-related changes in health system use. Few studies considered equity in their analyses and no studies directly mentioned equity. All included studies had a moderate to high risk of bias. CONCLUSIONS: COVID-19 led to mixed effects on AMR, which depended on the setting and context. There is a need for more rigorous studies that examine how COVID-19 impacted the health system as well as socioeconomic determinants to provide evidence for future pandemics or health crises. Our findings also underscore the importance of integrating antimicrobial stewardship, robust infection prevention and equity-focused surveillance into pandemic preparedness to mitigate AMR risks in future public health emergencies.