Effects of the COVID-19 pandemic on antibiotic use and resistance in French hospitals, 2019-22: a retrospective ecological analysis of national surveillance data.

The COVID-19 pandemic led to major disruptions in health-care services at the hospital and community levels, with uncertain consequences on antibiotic resistance in hospitals. Here, we quantify changes of antibiotic resistance incidence during the COVID-19 pandemic in France. We extracted data from the French national surveillance system on antibiotic resistance and antibiotic use in hospitals between 2019 and 2022. Included were 692 551 incident isolates for five antibiotic-bacterium pairs isolated from 414 hospitals across 12 French regions. First, we evaluated changes in annual antibiotic use in 2020-22 compared with 2019. Then, we evaluated associations between resistant isolates incidence and COVID-19 indicators (pandemic periods or prevalence of patients with COVID-19) using negative binomial regression models accounting for autocorrelation and antibiotic use. Associations were assessed at the national level, in intensive care units (ICUs; n=85), and across geographical regions. The use of some antibiotics, including azithromycin, imipenem, and meropenem, significantly increased over the 2020-22 period compared with 2019. Concomitantly, the incidence of methicillin-resistant Staphylococcus aureus (up to 37% [95% CI 18-53]) and extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (up to 33% [16-46]) isolates significantly decreased during COVID-19 pandemic years in hospitals and ICUs. ESBL-producing Klebsiella pneumoniae showed a transient significant decrease in ICUs during periods of strong anti-COVID-19 interventions in the community (24% [6-39]), whereas no signal was found for ESBL-producing Enterobacter cloacae complex. Importantly, the incidence of carbapenem-resistant Pseudomonas aeruginosa isolates was associated with COVID-19 prevalence in hospitals (p<0⸱0001) and ICUs (p=0⸱0002), notably in the regions most affected by the pandemic. Our results highlight alterations in antibiotic use and pathogen-specific effects of the pandemic on antibiotic resistance in hospitals. Although the biological mechanisms underlying between-species differences remain unclear, these results provide insights into the potential effects of a viral pandemic on antibiotic resistance and support the need for pandemic preparedness in health-care facilities. l'Agence nationale de la recherche Labex Integrative Biology of Emerging Infectious Diseases.