{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:26:50Z","timestamp":1790267210522,"version":"4.1.0"},"reference-count":64,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: The COVID-19 pandemic accelerated the inappropriate use of antibiotics, amplifying the global threat of antimicrobial resistance (AMR), particularly in resource-limited healthcare settings. This study investigated AMR patterns in a tertiary care hospital, focusing on the impact of the COVID-19 pandemic on invasive bacterial pathogens. Methods: This retrospective observational study was conducted at the University Clinical Centre of the Republic of Srpska, analyzing AMR data from invasive bacterial isolates collected between 2015 and 2024, and assessing correlations between antibiotic utilization and resistance patterns during the study periods. Results: Among 4718 invasive bacterial isolates, Acinetobacter spp. (26.7%) and K. pneumoniae (20.8%) were the most prevalent. A significant increase in invasive isolates was observed during the COVID-19 period, particularly for K. pneumoniae (p = 0.003), P. aeruginosa (p = 0.017), Acinetobacter spp. (p = 0.013), and E. faecium (p = 0.028). The highest multidrug-resistant (MDR) rates were observed in Acinetobacter spp. (97% during COVID-19) and K. pneumoniae (&gt;80% post-COVID-19). Resistance increased significantly in K. pneumoniae to cephalosporins, fluoroquinolones, and carbapenems, and in P. aeruginosa and Acinetobacter spp. to carbapenems, while P. aeruginosa resistance to aminoglycosides declined. Strong correlations were found between carbapenems use and Acinetobacter spp. resistance (r = 0.861, p = 0.001), and vancomycin use and E. faecalis resistance (r = 0.798, p = 0.006). Moderate correlations were also observed between carbapenems use and resistance of K. pneumoniae and P. aeruginosa. Conclusions: These findings highlight the profound impact of the COVID-19 pandemic on AMR dynamics, particularly among Gram-negative pathogens, and underscore the urgent need for strengthened antimicrobial stewardship and targeted surveillance to curb the spread of MDR pathogens, especially in resource-limited hospitals.<\/jats:p>","DOI":"10.3390\/antibiotics14121179","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T08:59:46Z","timestamp":1763715586000},"page":"1179","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Impact of the COVID-19 Pandemic on Antimicrobial Resistance Trends in a Tertiary Care Teaching Hospital: A Ten-Year Surveillance Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6083-9583","authenticated-orcid":false,"given":"Vedrana","family":"Bari\u0161i\u0107","sequence":"first","affiliation":[{"name":"Clinical Pharmacy Department, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3924-7962","authenticated-orcid":false,"given":"Tijana","family":"Kova\u010devi\u0107","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9599-1999","authenticated-orcid":false,"given":"Maja","family":"Travar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Department of Clinical Microbiology, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6883-4739","authenticated-orcid":false,"given":"Ana","family":"Goli\u0107 Jeli\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6654-5351","authenticated-orcid":false,"given":"Pedja","family":"Kova\u010devi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9676-5785","authenticated-orcid":false,"given":"Katarina","family":"Vu\u010di\u0107evi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6087-5785","authenticated-orcid":false,"given":"Dragana","family":"Milakovi\u0107","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6643-1781","authenticated-orcid":false,"given":"Ranko","family":"\u0160krbi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Academy of Sciences and Arts of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Department of Pathologic Physiology, I.M. Sechenov First Moscow State Medical University, Moscow 119435, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1007\/s42399-021-00966-5","article-title":"Antimicrobial consumption among hospitalized patients with COVID-19 in Pakistan","volume":"3","author":"Salman","year":"2021","journal-title":"SN Compr. Clin. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"160461","DOI":"10.1016\/j.scitotenv.2022.160461","article-title":"Bacterial resistance to antibacterial agents: Mechanisms, control strategies, and implications for global health","volume":"860","author":"Li","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_3","unstructured":"World Health Organization (2022). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2022, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240062702."},{"key":"ref_4","unstructured":"World Health Organization. Regional Office for Europe (2025, March 15). Central Asian and European Surveillance of Antimicrobial Resistance: CAESAR manual: Version 3.0, 2019. Available online: https:\/\/iris.who.int\/handle\/10665\/346572."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.2147\/IDR.S173867","article-title":"Antibiotic resistance: A rundown of a global crisis","volume":"11","author":"Aslam","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.cmi.2020.12.018","article-title":"Antibiotic prescribing in patients with COVID-19: Rapid review and meta-analysis","volume":"27","author":"Langford","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.2147\/IDR.S299774","article-title":"Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience","volume":"14","author":"Vijay","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_8","unstructured":"(2025, March 17). WHO News, WHO Reports Widespread Overuse of Antibiotics in Patients Hospitalized with COVID-19, 2025. Available online: https:\/\/www.who.int\/news\/item\/26-04-2024-who-reports-widespread-overuse-of-antibiotics-in-patients--hospitalized-with-covid-19."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100220","DOI":"10.1016\/j.onehlt.2021.100220","article-title":"One Health drivers of antibacterial resistance: Quantifying the relative impacts of human, animal and environmental use and transmission","volume":"12","author":"Booton","year":"2021","journal-title":"One Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e179","DOI":"10.1016\/S2666-5247(22)00355-X","article-title":"Antimicrobial resistance in patients with COVID-19: A systematic review and meta-analysis","volume":"4","author":"Langford","year":"2023","journal-title":"Lancet Microbe"},{"key":"ref_11","unstructured":"Antimicrobial Resistance Collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet, 399, 629\u2013655."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e28403","DOI":"10.1002\/jmv.28403","article-title":"Bacterial profiles and their antibiotic resistance background in superinfections caused by multidrug-resistant bacteria among COVID-19 ICU patients from southwest Iran","volume":"95","author":"Akrami","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1186\/s13054-022-04108-8","article-title":"COVID investigators Co-infection and ICU-acquired infection in COIVD-19 ICU patients: A secondary analysis of the UNITE-COVID data set","volume":"26","author":"Kohler","year":"2022","journal-title":"Crit. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1186\/s13054-020-03013-2","article-title":"The challenge of ventilator-associated pneumonia diagnosis in COVID-19 patients","volume":"24","author":"Laterre","year":"2020","journal-title":"Crit. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1001\/jama.2020.2717","article-title":"Prevalence and Outcomes of Infection among Patients in Intensive Care Units in 2017","volume":"323","author":"Vincent","year":"2020","journal-title":"JAMA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e301","DOI":"10.1016\/S1473-3099(23)00124-X","article-title":"How can lessons from the COVID-19 pandemic enhance antimicrobial resistance surveillance and stewardship?","volume":"23","author":"Walia","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1566","DOI":"10.1002\/hsr2.1566","article-title":"Antibiotic resistance and the COVID-19 pandemic: A dual crisis with complex challenges in LMICs","volume":"6","author":"Gulumbe","year":"2023","journal-title":"Health Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1080\/22221751.2022.2030196","article-title":"Antibiotic resistance in hospital-acquired ESKAPE-E infections in low- and lower-middle-income countries: A systematic review and meta-analysis","volume":"11","author":"Ayobami","year":"2022","journal-title":"Emerg. Microbes Infect."},{"key":"ref_19","unstructured":"O\u2019Neill, J. (2025, March 17). The Review on Antimicrobial Resistance. Tackling Drug-Resistant Infections Globally. Final Report and Recommendations, 2016. Available online: https:\/\/amr-review.org\/sites\/default\/files\/160518_Final%20paper_with%20cover.pdf."},{"key":"ref_20","unstructured":"European Centre for Disease Prevention and Control (ECDC) (2022). Assessing the Health Burden of Infections with Antibiotic-Resistant Bacteria in the EU\/EEA, 2016\u20132020, ECDC. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/health-burden-infections-antibiotic-resistant-bacteria-2016-2020."},{"key":"ref_21","unstructured":"(2025, March 17). WHO Health Topics, Antimicrobial Resistance, 2025. Available online: https:\/\/www.who.int\/health-topics\/antimicrobial-resistance."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.medin.2019.06.008","article-title":"Comparison of the defined daily dose and days of treatment methods for evaluating the consumption of antibiotics and antifungals in the intensive care unit","volume":"44","author":"Fondevilla","year":"2020","journal-title":"Med. Intensiv. (Engl. Ed.)"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Parisini, A., Boni, S., Vacca, E.B., Bobbio, N., Puente, F.D., Feasi, M., Prinapori, R., Lattuada, M., Sartini, M., and Cristina, M.L. (2023). Impact of the COVID-19 Pandemic on Epidemiology of Antibiotic Resistance in an Intensive Care Unit (ICU): The Experience of a North-West Italian Center. Antibiotics, 12.","DOI":"10.3390\/antibiotics12081278"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Liu, Y., Song, H., Wu, Y., Liu, L., Li, N., Zhang, M., Li, Y., and Meng, X. (2025). Influence of COVID-19 pandemic on the distribution and drug resistance of pathogens in patients with bloodstream infection. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1607801"},{"key":"ref_25","unstructured":"European Centre for Disease Prevention and Control and World Health Organization (2023). Antimicrobial Resistance Surveillance in Europe 2023\u20132021 Data, European Centre for Disease Prevention and Control and World Health Organization. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/antimicrobial-resistance-surveillance-europe-2023-2021-data."},{"key":"ref_26","unstructured":"European Centre for Disease Prevention and Control and WHO Regional Office for Europe (2024). Surveillance of Antimicrobial Resistance in Europe, 2023 Data: Executive Summary, European Centre for Disease Prevention and Control. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/surveillance-antimicrobial-resistance-europe-2023-data-executive-summary."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Kachalov, V.N., Nguyen, H., Balakrishna, S., Salazar-Vizcaya, L., Sommerstein, R., Kuster, S.P., Hauser, A., Abel Zur Wiesch, P., Klein, E., and Kouyos, R.D. (2021). Identifying the drivers of multidrug-resistant Klebsiella pneumoniae at a European level. PLoS Comput. Biol., 17.","DOI":"10.1371\/journal.pcbi.1008446"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Cire\u0219\u0103, A., T\u0103l\u0103pan, D., Vasile, C.C., Popescu, C., and Popescu, G.A. (2024). Evolution of Antimicrobial Resistance in Klebsiella pneumoniae over 3 Years (2019\u20132021) in a Tertiary Hospital in Bucharest, Romania. Antibiotics, 13.","DOI":"10.3390\/antibiotics13050431"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Yakobi, S.H., and Nwodo, U.U. (2025). Prevalence of Antimicrobial Resistance in Klebsiella pneumoniae in the South African Populations: A Systematic Review and Meta-Analysis of Surveillance Studies. Microbiologyopen, 14.","DOI":"10.1002\/mbo3.70037"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"220","DOI":"10.4103\/2141-9248.113666","article-title":"Antibiotic prescriptions in critically-ill patients: A latin american experience","volume":"3","author":"Curcio","year":"2013","journal-title":"Ann. Med. Health Sci. Res."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tabah, A., Lipman, J., Barbier, F., Buetti, N., Timsit, J.F., and on Behalf of the Escmid Study Group For Infections In Critically Ill Patients-Esgcip (2022). Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review. Antibiotics, 11.","DOI":"10.3390\/antibiotics11030362"},{"key":"ref_32","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_33","doi-asserted-by":"crossref","unstructured":"Novovi\u0107, K., Kuzmanovi\u0107 Nedeljkovi\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_34","doi-asserted-by":"crossref","unstructured":"Brkic, S., and Cirkovic, I. (2024). Carbapenem-Resistant Enterobacterales in the Western Balkans: Addressing Gaps in European AMR Surveillance Map. Antibiotics, 13.","DOI":"10.3390\/antibiotics13090895"},{"key":"ref_35","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_36","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1093\/jac\/dkaf136","article-title":"Decline of antimicrobial resistance in Pseudomonas aeruginosa bacteraemia following the COVID-19 pandemic: A longitudinal observational study","volume":"80","author":"Butscheid","year":"2025","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4113","DOI":"10.2147\/IDR.S409726","article-title":"Antimicrobial Resistance Pattern of Pseudomonas aeruginosa: An 11-Year Experience in a Tertiary Care Hospital in Makkah, Saudi Arabia","volume":"16","author":"Momenah","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Domon, H., Hirayama, S., Isono, T., Sasagawa, K., Takizawa, F., Maekawa, T., Yanagihara, K., and Terao, Y. (2023). Macrolides Decrease the Proinflammatory Activity of Macrolide-Resistant Streptococcus pneumoniae. Microbiol. Spectr., 11.","DOI":"10.1128\/spectrum.00148-23"},{"key":"ref_39","first-page":"756","article-title":"The Crisis of Macrolide Resistance in Pneumococci in Latin America","volume":"111","author":"Creel","year":"2024","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Schroeder, M.R., and Stephens, D.S. (2016). Macrolide Resistance in Streptococcus pneumoniae. Front. Cell. Infect. Microbiol., 6.","DOI":"10.3389\/fcimb.2016.00098"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Kastrin, T., Mio\u010d, V., Mahni\u010d, A., \u010ci\u017eman, M., and Slovenian Meningitidis Study Group (2023). Impact of the COVID-19 Pandemic on Community Consumption of Antibiotics for Systemic Use and Resistance of Invasive Streptococcus pneumoniae in Slovenia. Antibiotics, 12.","DOI":"10.3390\/antibiotics12060945"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"102707","DOI":"10.1016\/j.jiph.2025.102707","article-title":"Evaluating antibiotic susceptibility trends in S. pneumoniae and H. influenzae isolates during the COVID-19 pandemic: An interrupted time series analysis of a nationwide antimicrobial resistance database","volume":"18","author":"Miyamori","year":"2025","journal-title":"J. Infect. Public. Health"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Guan, L., Beig, M., Wang, L., Navidifar, T., Moradi, S., Motallebi Tabaei, F., Teymouri, Z., Abedi Moghadam, M., and Sedighi, M. (2024). Global status of antimicrobial resistance in clinical Enterococcus faecalis isolates: Systematic review and meta-analysis. Ann. Clin. Microbiol. Antimicrob., 23.","DOI":"10.1186\/s12941-024-00728-w"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Huang, C., Moradi, S., Sholeh, M., Tabaei, F.M., Lai, T., Tan, B., Meng, J., and Azizian, K. (2025). Global trends in antimicrobial resistance of Enterococcus faecium: A systematic review and meta-analysis of clinical isolates. Front. Pharmacol., 16.","DOI":"10.3389\/fphar.2025.1505674"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Radford-Smith, D.E., and Anthony, D.C. (2025). Vancomycin-Resistant E. faecium: Addressing Global and Clinical Challenges. Antibiotics, 14.","DOI":"10.3390\/antibiotics14050522"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Brinkwirth, S., Martins, S., Ayobami, O., Feig, M., Noll, I., Zacher, B., Eckmanns, T., Werner, G., Willrich, N., and Haller, S. (2022). Germany\u2019s Burden of Disease of Bloodstream Infections Due to Vancomycin-Resistant Enterococcus faecium between 2015\u20132020. Microorganisms, 10.","DOI":"10.3390\/microorganisms10112273"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Boccabella, L., Palma, E.G., Abenavoli, L., Scarlata, G.G.M., Boni, M., Ianiro, G., Santori, P., Tack, J.F., and Scarpellini, E. (2024). Post-Coronavirus Disease 2019 Pandemic Antimicrobial Resistance. Antibiotics, 13.","DOI":"10.3390\/antibiotics13030233"},{"key":"ref_48","unstructured":"World Health Organization (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. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240093461."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Mrvi\u010d, T., Stevanoska, S., Beovi\u0107, B., Logar, M., Gregor\u010di\u010d, S., \u017dnidar\u0161i\u010d, B., Seme, K., Velimirovi\u0107, I., \u0160vent Ku\u010dina, N., and Maver Vodi\u010dar, P. (2024). The Impact of COVID-19 on Multidrug-Resistant Bacteria at a Slovenian Tertiary Medical Center. Antibiotics, 13.","DOI":"10.3390\/antibiotics13030214"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Gamaleldin, P., Alseqely, M., Evans, B.A., Omar, H., and Abouelfetouh, A. (2024). Comparison of genotypic features between two groups of antibiotic resistant Klebsiella pneumoniae clinical isolates obtained before and after the COVID-19 pandemic from Egypt. BMC Genom., 25.","DOI":"10.1186\/s12864-024-10661-z"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s13756-023-01346-5","article-title":"Epidemiology of multidrug-resistant Klebsiella pneumoniae infection in clinical setting in South-Eastern Asia: A systematic review and meta-analysis","volume":"12","author":"Salawudeen","year":"2023","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_52","first-page":"101004","article-title":"World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): A prospective, multicentre, observational study","volume":"43","author":"Antochevis","year":"2025","journal-title":"Lancet Reg. Health Am."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Kousovista, R., Athanasiou, C., Liaskonis, K., Ivopoulou, O., Ismailos, G., and Karalis, V. (2021). Correlation between Acinetobacter baumannii Resistance and Hospital Use of Meropenem, Cefepime, and Ciprofloxacin: Time Series Analysis and Dynamic Regression Models. Pathogens, 10.","DOI":"10.3390\/pathogens10040480"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Kasbi, Y., Sellami, F., Ferjani, A., Abbassi, A., and Boutiba Ben Boubaker, I. (2025). Pharmaco-Epidemiological Study and Correlation Between Antibiotic Resistance and Antibiotic Consumption in a Tunisian Teaching Hospital from 2010 to 2022. Antibiotics, 14.","DOI":"10.3390\/antibiotics14020135"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1080\/21505594.2016.1222343","article-title":"The global epidemiology of carbapenemase-producing Enterobacteriaceae","volume":"8","author":"Doi","year":"2017","journal-title":"Virulence"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Medic, D., Bozic Cvijan, B., and Bajcetic, M. (2023). Impact of Antibiotic Consumption on Antimicrobial Resistance to Invasive Hospital Pathogens. Antibiotics, 12.","DOI":"10.3390\/antibiotics12020259"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2920","DOI":"10.1128\/AAC.46.9.2920-2925.2002","article-title":"Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa","volume":"46","author":"Lepper","year":"2002","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Ramatla, T., Nkhebenyane, J., Lekota, K.E., Thekisoe, O., Monyama, M., Achilonu, C.C., and Khasapane, G. (2025). Global prevalence and antibiotic resistance profiles of carbapenem-resistant Pseudomonas aeruginosa reported from 2014 to 2024: A systematic review and meta-analysis. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1599070"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Bari\u0161i\u0107, V., Kova\u010devi\u0107, T., Travar, M., Goli\u0107 Jeli\u0107, A., Kova\u010devi\u0107, P., Milakovi\u0107, D., and \u0160krbi\u0107, R. (2025). A Retrospective Study of the Impact of the COVID-19 Pandemic on the Utilization and Quality of Antibiotic Use in a Tertiary Care Teaching Hospital in Low-Resource Settings. Antibiotics, 14.","DOI":"10.3390\/antibiotics14060535"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1016\/j.cmi.2022.03.014","article-title":"Exposure to World Health Organization\u2019s AWaRe antibiotics and isolation of multidrug resistant bacteria: A systematic review and meta-analysis","volume":"28","author":"Sulis","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1007\/s11096-023-01603-y","article-title":"Antimicrobial utilization and resistance in Pseudomonas aeruginosa using segmented regression analysis: A comparative study between Serbia and eight European Countries","volume":"45","author":"Tomic","year":"2023","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s11908-022-00788-z","article-title":"Les mis\u00e9rables: A Parallel Between Antimicrobial Resistance and COVID-19 in Underdeveloped and Developing Countries","volume":"24","author":"Gontijo","year":"2022","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_63","unstructured":"(2025, March 17). EUCAST Clinical Breakpoints. Available online: https:\/\/www.eucast.org\/clinical_breakpoints."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Jain, N., Jansone, I., Obidenova, T., Simanis, R., Meisters, J., Straupmane, D., and Reinis, A. (2021). Antimicrobial Resistance in Nosocomial Isolates of Gram-Negative Bacteria: Public Health Implications in the Latvian Context. Antibiotics, 10.","DOI":"10.3390\/antibiotics10070791"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/12\/1179\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T09:31:58Z","timestamp":1763717518000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/12\/1179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,21]]},"references-count":64,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["antibiotics14121179"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14121179","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,21]]}}}