{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:19:30Z","timestamp":1790882370173,"version":"4.1.0"},"reference-count":67,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Project of Ministry of Science, Technological Development and Innovation of Republic of Serbia","award":["200110"],"award-info":[{"award-number":["200110"]}]},{"name":"Project of Ministry of Science, Technological Development and Innovation of Republic of Serbia","award":["50-138"],"award-info":[{"award-number":["50-138"]}]},{"name":"Innovation Fund of the Republic of Serbia","award":["200110"],"award-info":[{"award-number":["200110"]}]},{"name":"Innovation Fund of the Republic of Serbia","award":["50-138"],"award-info":[{"award-number":["50-138"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: The aims of this paper are to examine the impact of the COVID-19 pandemic on the non-rational use of antibiotics and potential alterations in the antibiotic resistance profiles of multi-drug resistant (MDR) isolates of Klebsiella pneumoniae (KPN), Pseudomonas aeruginosa (PAE), and Acinetobacter baumannii (ABA). Material and Methods: This study was conducted at the tertiary University Hospital \u201cDr Dragisa Misovic-Dedinje\u201d (Belgrade, Serbia) and was divided into three periods: pre-pandemic (1.4.2019\u201331.3.2020, period I), COVID-19 pandemic (1.4.2020\u201331.3.2021, period II), and COVID-19 pandemic-second phase (1.4.2021\u201331.3.2022, period III). Cultures were taken from each patient with clinically suspected infection (symptoms, biochemical markers of infection). All departments of the hospital were included in this study. Based on the source, all microbiological specimens were divided into 1\u00b0 blood, 2\u00b0 respiratory tract (tracheal aspirate, bronchoalveolar lavage fluid, throat, sputum), 3\u00b0 central-line catheter, 4\u00b0 urine, 5\u00b0 urinary catheter, 6\u00b0 skin and soft tissue, and 6\u00b0 other (peritoneal fluid, drainage sample, bioptate, bile, incisions, fistulas, and abscesses). After the isolation of bacterial strains from the samples, an antibiotic sensitivity test was performed for each individual isolate with the automated Vitek\u00ae 2 COMPACT. Antibiotic consumption testing was performed by the WHO guideline equations (ATC\/DDD). Results: A total of 2196 strains of KPN, PAE, and ABA from 41,144 hospitalized patients were isolated (23.6% of the number of total isolates). The number of ABA isolates statistically increased (p = 0.021), while the number of PAE isolates statistically decreased (p = 0.003) during the pandemic. An increase in the percentage of MDR strains was observed for KPN (p = 0.028) and PAE (p = 0.027). There has been an increase in the antibiotic resistance of KPN for piperacillin\u2013tazobactam, the third and fourth generations of cephalosporins (ceftriaxone, ceftazidime, and cefepime), all carbapanems (imipenem, meropenem, and ertapenem), and levofloxacin; of PAE for imipenem; and of ABA for amikacin. Total antibiotic consumption increased (from 755 DBD to 1300 DBD, +72%), especially in the watch and reserve group of antibiotics. The highest increases were noted for vancomycin, levofloxacin, azithromycin, and meropenem. MV positively correlated with the increased occurrence of MDR KPN (r = 0.35, p = 0.009) and MDR PAE (r = 0.43, p = 0.009) but not for MDR ABA (r = 0.09, p = 0.614). There has been a statistically significant increase in the Candida sp. isolates, but the prevalence of Clostridium difficile infection remained unchanged. Conclusions: The COVID-19 pandemic has influenced the increase in total and MDR strains of KPN, ABA, and PAE and worsened their antibiotic resistance profiles. An increase in the consumption of both total and specific antibiotics was observed, mostly of fluoroquinolones and carbapenems. A positive correlation between the number of patients on MV and an increase in MDR KPN and MDR PAE strains was noted. It is necessary to adopt and demand the implementation of appropriate antimicrobial stewardship interventions to decrease the resistance of intrahospital pathogens to antibiotics.<\/jats:p>","DOI":"10.3390\/antibiotics14090871","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T16:42:21Z","timestamp":1756485741000},"page":"871","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Increased Antimicrobial Consumption, Isolation Rate, and Resistance Profiles of Multi-Drug Resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii During the COVID-19 Pandemic in a Tertiary Healthcare Institution"],"prefix":"10.3390","volume":"14","author":[{"given":"Predrag","family":"Savic","sequence":"first","affiliation":[{"name":"University Hospital Centre Dr Dragisa Misovic\u2013Dedinje, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5503-8837","authenticated-orcid":false,"given":"Ljiljana Gojkovic","family":"Bukarica","sequence":"additional","affiliation":[{"name":"University Hospital Centre Dr Dragisa Misovic\u2013Dedinje, 11000 Belgrade, Serbia"},{"name":"Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6321-7376","authenticated-orcid":false,"given":"Predrag","family":"Stevanovic","sequence":"additional","affiliation":[{"name":"University Hospital Centre Dr Dragisa Misovic\u2013Dedinje, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Vitorovic","sequence":"additional","affiliation":[{"name":"University Hospital Centre Dr Dragisa Misovic\u2013Dedinje, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7609-4504","authenticated-orcid":false,"given":"Zoran","family":"Bukumiric","sequence":"additional","affiliation":[{"name":"Institute of Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivera","family":"Vucicevic","sequence":"additional","affiliation":[{"name":"University Hospital Centre Dr Dragisa Misovic\u2013Dedinje, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nenad","family":"Milanov","sequence":"additional","affiliation":[{"name":"University Hospital Centre Dr Dragisa Misovic\u2013Dedinje, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6282-7092","authenticated-orcid":false,"given":"Vladimir","family":"Zivanovic","sequence":"additional","affiliation":[{"name":"University Hospital Centre Dr Dragisa Misovic\u2013Dedinje, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0096-2181","authenticated-orcid":false,"given":"Ana","family":"Bukarica","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases Dedinje, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8941-8088","authenticated-orcid":false,"given":"Milos","family":"Gostimirovic","sequence":"additional","affiliation":[{"name":"Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"ref_1","unstructured":"(2025). World Map of Cumulative Confirmed COVID-19 Deaths per Million People, Our World in Data."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"102304","DOI":"10.1016\/j.isci.2021.102304","article-title":"The silent pandemic: Emergent antibiotic resistances following the global response to SARS-CoV-2","volume":"24","author":"Mahoney","year":"2021","journal-title":"iScience"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"114006","DOI":"10.1016\/j.ijheh.2022.114006","article-title":"Prevalence of ESKAPE pathogens in the environment: Antibiotic resistance status, community-acquired infection and risk to human health","volume":"244","author":"Denissen","year":"2022","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Tang, K.W.K., Millar, B.C., and Moore, J.E. (2023). Antimicrobial Resistance (AMR). Br. J. Biomed. Sci., 80.","DOI":"10.3389\/bjbs.2023.11387"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.cmi.2020.09.055","article-title":"Antibiotic use in the COVID-19 crisis in Spain","volume":"27","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_6","first-page":"399","article-title":"Rational use of antibiotics during the COVID-19 pandemic","volume":"2","author":"Radin","year":"2021","journal-title":"Serbian J. Med. Chamb."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3764","DOI":"10.1128\/IAI.00298-15","article-title":"Influenza and Bacterial Superinfection: Illuminating the Immunologic Mechanisms of Disease","volume":"83","author":"Robinson","year":"2015","journal-title":"Infect. Immun."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Simonsen, L., Spreeuwenberg, P., Lustig, R., Taylor, R.J., Fleming, D.M., Kroneman, M., Van Kerkhove, M.D., Mounts, A.W., and Paget, W.J. (2013). GLaMOR Collaborating Teams. Global mortality estimates for the 2009 Influenza Pandemic from the GLaMOR project: A modeling study. PLoS Med., 10.","DOI":"10.1371\/journal.pmed.1001558"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Abu-Rub, L.I., Abdelrahman, H.A., Johar, A.A., Alhussain, H.A., Hadi, H.A., and Eltai, N.O. (2021). Antibiotics Prescribing in Intensive Care Settings during the COVID-19 Era: A Systematic Review. Antibiotics, 10.","DOI":"10.3390\/antibiotics10080935"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s11739-021-02790-0","article-title":"Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: A retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers","volume":"17","author":"Wuyts","year":"2022","journal-title":"Intern. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tomas, A., Pavlovi\u0107, N., Stilinovi\u0107, N., Horvat, O., Paut-Kusturica, M., Dugand\u017eija, T., Tomi\u0107, Z., and Sabo, A. (2021). Increase and Change in the Pattern of Antibiotic Use in Serbia (2010\u20132019). Antibiotics, 10.","DOI":"10.3390\/antibiotics10040397"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Zivanovic, V., Gojkovic-Bukarica, L., Scepanovic, R., Vitorovic, T., Novakovic, R., Milanov, N., Bukumiric, Z., Carevic, B., Trajkovic, J., and Rajkovic, J. (2017). Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0175689"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"So\u010dan, M., Mrzel, M., Prosenc, K., Korva, M., Av\u0161i\u010d-\u017dupanc, T., Poljak, M., Lunar, M.M., and Zupani\u010d, T. (2024). Comparing COVID-19 severity in patients hospitalized for community-associated Delta, BA.1 and BA.4\/5 variant infection. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1294261"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Karageorgou, V., Papaioannou, A.I., Kallieri, M., Blizou, M., Lampadakis, S., Sfika, M., Krouskos, A., Papavasileiou, V., Strakosha, F., and Vandorou, K.T. (2023). Patients Hospitalized for COVID-19 in the Periods of Delta and Omicron Variant Dominance in Greece: Determinants of Severity and Mortality. J. Clin. Med., 12.","DOI":"10.3390\/jcm12185904"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S1473-3099(21)00475-8","article-title":"Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: A cohort study","volume":"22","author":"Twohig","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_17","unstructured":"European Centre for Disease Prevention and Control (2022). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2020, ECDC."},{"key":"ref_18","unstructured":"European Centre for Disease Prevention and Control (2022). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2021, ECDC."},{"key":"ref_19","unstructured":"Centers for Disease Control and Prevention (2023). HAI Pathogens and Antimicrobial Resistance Report, 2018\u20132021."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"\u0106irkovi\u0107, I., Markovi\u0107-Deni\u0107, L., Baj\u010deti\u0107, M., Dragovac, G., \u0110or\u0111evi\u0107, Z., Mioljevi\u0107, V., Uro\u0161evi\u0107, D., Nikoli\u0107, V., Despotovi\u0107, A., and Krtini\u0107, G. (2022). Microbiology of Healthcare-Associated Infections: Results of a Fourth National Point Prevalence Survey in Serbia. Antibiotics, 11.","DOI":"10.3390\/antibiotics11091161"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Yahya, R.O. (2022). Problems Associated with Co-Infection by Multidrug-Resistant Klebsiella pneumoniae in COVID-19 Patients: A Review. Healthcare, 10.","DOI":"10.3390\/healthcare10122412"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Raoofi, S., PashazadehKan, F., Rafiei, S., Hosseinipalangi, Z., NooraniMejareh, Z., Khani, S., Abdollahi, B., SeyghalaniTalab, F., Sanaei, M., and Zarabi, F. (2023). Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0274248"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s13756-023-01240-0","article-title":"Incremental costs of hospital-acquired infections in COVID-19 patients in an adult intensive care unit of a tertiary hospital from a low-resource setting","volume":"12","year":"2023","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_24","first-page":"178","article-title":"Antimicrobial resistance pattern in healthcare-associated infections: Investigation of in-hospital risk factors","volume":"13","author":"Meybodi","year":"2021","journal-title":"Iran. J. Microbiol."},{"key":"ref_25","unstructured":"European Centre for Disease Prevention and Control (2020). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2019, ECDC."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bentivegna, E., Luciani, M., Arcari, L., Santino, I., Simmaco, M., and Martelletti, P. (2021). Reduction of Multidrug-Resistant (MDR) Bacterial Infections during the COVID-19 Pandemic: A Retrospective Study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18031003"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Xu, L., Sun, X., and Ma, X. (2017). Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae. Ann. Clin. Microbiol. Antimicrob., 16.","DOI":"10.1186\/s12941-017-0191-3"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Luchian, N., Olaru, I., Ple\u0219ea-Condratovici, A., DuceacCovrig, M., M\u0103t\u0103saru, M., Dabija, M.G., Elkan, E.M., Dabija, V.A., Eva, L., and Duceac, L.D. (2025). Clinical and Epidemiological Aspects on Healthcare-Associated Infections with Acinetobacter spp. in a Neurosurgery Hospital in North-East Romania. Medicina, 61.","DOI":"10.3390\/medicina61060990"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"20503121211001144","DOI":"10.1177\/20503121211001144","article-title":"Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience","volume":"9","author":"Alotaibi","year":"2021","journal-title":"SAGE Open Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13756-024-01376-7","article-title":"Prevalence of colistin resistance in clinical isolates of Acinetobacter baumannii: A systematic review and meta-analysis","volume":"13","author":"Bostanghadiri","year":"2024","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Sokolovi\u0107, D., Drakul, D., Vuji\u0107-Aleksi\u0107, V., Joksimovi\u0107, B., Mari\u0107, S., and Ne\u017ei\u0107, L. (2023). Antibiotic consumption and antimicrobial resistance in the SARS-CoV-2 pandemic: A single-center experience. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1067973"},{"key":"ref_32","unstructured":"WHO (2024). WHO Bacterial Priority Pathogens List, 2024: Bacterial Pathogens of Public Health Importance to Guide Research, Development and Strategies to Prevent and Control Antimicrobial Resistance, World Health Organization."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Mesquita, G.P., Costa, M.C.C., Silva, M.A., Ara\u00fajo, L.G., Vila Nova, B.G., Castro, \u00c9.J.M., Castelo Branco, L.C.M., Silva, R.C.S.D., Marques, S.G., and Abreu, A.G. (2023). Antimicrobial resistance of Pseudomonas aeruginosa isolated from patients with pneumonia during the COVID-19 pandemic and pre-pandemic periods in Northeast Brazil. Braz. J. Med. Biol. Res., 56.","DOI":"10.1590\/1414-431x2023e12726"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Serretiello, E., Manente, R., Dell\u2019Annunziata, F., Folliero, V., Iervolino, D., Casolaro, V., Perrella, A., Santoro, E., Galdiero, M., and Capunzo, M. (2023). Antimicrobial Resistance in Pseudomonas aeruginosa before and during the COVID-19 Pandemic. Microorganisms, 11.","DOI":"10.3390\/microorganisms11081918"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2765","DOI":"10.2147\/IDR.S402894","article-title":"Epidemiology and Multidrug Resistance of Pseudomonas aeruginosa and Acinetobacter baumanni Isolated from Clinical Samples in Ethiopia","volume":"16","author":"Araya","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"4115","DOI":"10.2147\/IDR.S268744","article-title":"Risk Factors for Mortality of Inpatients with Pseudomonas aeruginosa Bacteremia in China: Impact of Resistance Profile in the Mortality","volume":"13","author":"Zhang","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_37","unstructured":"WHO (2024). WHO Reports Widespread Overuse of Antibiotics in Patients Hospitalized with COVID-19, WHO."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"101848","DOI":"10.1016\/j.eclinm.2023.101848","article-title":"Global antibiotic use during the COVID-19 pandemic: Analysis of pharmaceutical sales data from 71 countries, 2020\u20132022","volume":"57","author":"Nandi","year":"2023","journal-title":"eClinicalMedicine"},{"key":"ref_39","unstructured":"Sullivan, C., Fisher, C.R., Grabowsky, L., Sertkaya, A., Berlind, A., and Mallick, S. (2025). Combating Antimicrobial Resistance During the COVID19 Pandemic: Perceived Risks and Protective Practices."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Despotovi\u0107, A., Bara\u0107, A., Cucani\u0107, T., Cucani\u0107, K., and Stevanovi\u0107, G. (2022). Antibiotic (Mis)Use in COVID-19 Patients before and after Admission to a Tertiary Hospital in Serbia. Antibiotics, 11.","DOI":"10.3390\/antibiotics11070847"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Priji\u0107, A., Gazibara, T., Priji\u0107, S., Mandi\u0107-Raj\u010devi\u0107, S., and Maksimovi\u0107, N. (2022). Factors Associated with the Antibiotic Treatment of Children Hospitalized for COVID-19 during the Lockdown in Serbia. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192315590"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.ajic.2023.09.005","article-title":"Trends and patterns of antibiotics use in Serbia from 2006 to 2021: Pre-COVID-19 period versus COVID-19 pandemic","volume":"52","author":"Filimonovic","year":"2024","journal-title":"Am. J. Infect. Control"},{"key":"ref_43","unstructured":"European Centre for Disease Prevention and Control (2022). Antimicrobial Consumption in the EU\/EEA (ESAC-Net)\u2014Annual Epidemiological Report 2021, ECDC."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Andrews, A., Budd, E.L., Hendrick, A., Ashiru-Oredope, D., Beech, E., Hopkins, S., Gerver, S., and Muller-Pebody, B. (2021). The Amu Covid-Stakeholder Group. Surveillance of Antibacterial Usage during the COVID-19 Pandemic in England, 2020. Antibiotics, 10.","DOI":"10.3390\/antibiotics10070841"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Malik, S.S., and Mundra, S. (2022). Increasing Consumption of Antibiotics during the COVID-19 Pandemic: Implications for Patient Health and Emerging Anti-Microbial Resistance. Antibiotics, 12.","DOI":"10.3390\/antibiotics12010045"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"927","DOI":"10.2147\/CEOR.S337621","article-title":"Analysis of the Prescription of Antibiotics During the Implementation of COVID-19 Personal Protection Measures in a Regional Health System","volume":"13","year":"2021","journal-title":"Clin. Outcomes Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.2147\/IDR.S460148","article-title":"The Trend of Antibiotic Consumption After the COVID-19 Pandemic: Approach to Future Outbreaks","volume":"17","author":"Elsafi","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Foxlee, N.D., Lui, A., Mathias, A., Townell, N., and Lau, C.L. (2022). Antibiotic Consumption in Vanuatu before and during the COVID-19 Pandemic, 2018 to 2021: An Interrupted Time Series Analysis. Trop. Med. Infect. Dis., 8.","DOI":"10.3390\/tropicalmed8010023"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Massarine, N.C.M., de Souza, G.H.A., Nunes, I.B., Salom\u00e9, T.M., Barbosa, M.D.S., Faccin, I., Rossato, L., and Simionatto, S. (2023). How Did COVID-19 Impact the Antimicrobial Consumption and Bacterial Resistance Profiles in Brazil?. Antibiotics, 12.","DOI":"10.3390\/antibiotics12091374"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Fukushige, M., Ngo, N.H., Lukmanto, D., Fukuda, S., and Ohneda, O. (2022). Effect of the COVID-19 pandemic on antibiotic consumption: A systematic review comparing 2019 and 2020 data. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.946077"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Rusic, D., Vilovic, M., Bukic, J., Leskur, D., SeseljaPerisin, A., Kumric, M., Martinovic, D., Petric, A., Modun, D., and Bozic, J. (2021). Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks. Life, 11.","DOI":"10.3390\/life11030220"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Granata, G., Schiavone, F., Pipitone, G., Taglietti, F., and Petrosillo, N. (2022). Antibiotics Use in COVID-19 Patients: A Systematic Literature Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237207"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"106243","DOI":"10.1016\/j.ijantimicag.2020.106243","article-title":"Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open label non-randomized clinical trial revisited","volume":"57","author":"Gautret","year":"2021","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_54","unstructured":"(2025, June 05). COVID-19 Rapid Guideline: Managing COVID-19, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK571450\/."},{"key":"ref_55","unstructured":"(2025, June 05). COVID-19 Rapid Guideline: Managing Symptoms (Including at the End of Life) in the Community, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK566885\/."},{"key":"ref_56","unstructured":"World Health Organization (2020). Clinical Management of COVID-19: Interim Guidance, World Health Organization. Available online: https:\/\/iris.who.int\/handle\/10665\/332196."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1089\/mdr.2020.0489","article-title":"Multidrug-Resistant Infections and Outcome of Critically Ill Patients with Coronavirus Disease 2019: A Single Center Experience","volume":"27","author":"Karruli","year":"2021","journal-title":"Microb. Drug Resist."},{"key":"ref_58","first-page":"e57489","article-title":"Antimicrobial Resistance Profile in ICU Patients Across India: A Multicenter, Retrospective, Observational Study","volume":"16","author":"Verma","year":"2024","journal-title":"Cureus"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"dlaa129","DOI":"10.1093\/jacamr\/dlaa129","article-title":"Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU","volume":"3","author":"Moise","year":"2021","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.cmi.2020.10.021","article-title":"COVID-BioB study group. Secondary infections in patients hospitalized with COVID-19: Incidence and predictive factors","volume":"27","author":"Ripa","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Temperoni, C., Caiazzo, L., and Barchiesi, F. (2021). High Prevalence of Antibiotic Resistance among Opportunistic Pathogens Isolated from Patients with COVID-19 under Mechanical Ventilation: Results of a Single-Center Study. Antibiotics, 10.","DOI":"10.3390\/antibiotics10091080"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Novovi\u0107, K., Kuzmanovi\u0107Nedeljkovi\u0107, S., Poledica, M., Nikoli\u0107, G., Gruji\u0107, B., Jov\u010di\u0107, B., Koji\u0107, M., and Filipi\u0107, B. (2023). Virulence potential of multidrug-resistant Acinetobacter baumannii isolates from COVID-19 patients on mechanical ventilation: The first report from Serbia. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1094184"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Araujo, J.M., de Almeida Junior, J.N., Magri, M.M.C., Costa, S.F., and Guimar\u00e3es, T. (2024). Epidemiological Assessment and Risk Factors for Mortality of Bloodstream Infections by Candida sp. and the Impact of the COVID-19 Pandemic Era. J. Fungi, 10.","DOI":"10.3390\/jof10040268"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.ijid.2020.06.044","article-title":"COVID-19 epidemic in Brazil: Where are we at?","volume":"97","author":"Lobo","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1093\/cid\/ciab562","article-title":"The Landscape of CandidemiaDuring the Coronavirus Disease 2019 (COVID-19) Pandemic","volume":"74","author":"Seagle","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Davies, K., Lawrence, J., Berry, C., Davis, G., Yu, H., Cai, B., Gonzalez, E., Prantner, I., Kurcz, A., and Macovei, I. (2020). Risk Factors for Primary Clostridium difficile Infection; Results From the Observational Study of Risk Factors for Clostridium difficile Infection in Hospitalized Patients With Infective Diarrhea (ORCHID). Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.00293"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"17562848231165581","DOI":"10.1177\/17562848231165581","article-title":"The impact of the COVID-19 pandemic on Clostridioides difficile infection and utilization of fecal microbiota transplantation","volume":"16","author":"Bachour","year":"2023","journal-title":"Ther. Adv. Gastroenterol."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/9\/871\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:35:18Z","timestamp":1760034918000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/9\/871"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":67,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["antibiotics14090871"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14090871","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]}}}