A modeling study on the impact of COVID-19 pandemic responses on the community transmission of antibiotic-resistant bacteria

AbstractNon-pharmaceutical COVID-19 interventions have dramatically modified the transmission dynamics of pathogens other than SARS-CoV-2. In many countries, reports have shown that implementation of population-wide lockdowns led to substantial reductions in invasive bacterial disease caused by respiratory bacteria such asStreptococcus pneumoniae. By contrast, most European countries reported increased antibiotic resistance amongS. pneumoniaeisolates from 2019 to 2020. To disentangle impacts of the COVID-19 pandemic responses on bacterial epidemiology in the community setting, we propose a mathematical model formalizing simultaneous transmission of SARS-CoV-2 and antibiotic-sensitive and -resistant strains ofS. pneumoniae. The impacts of population-wide lockdowns, isolation of COVID-19 cases, changes in antibiotic consumption due to altered healthcare-seeking behavior and prophylactic use in the early pandemic were explored across six pandemic scenarios. Our model was able to reproduce the observed trends, showing how lockdowns substantially reduce invasive pneumococcal disease incidence, while surges in prophylactic antibiotic prescribing favor disease caused by resistant strains. Surges in COVID-19 cases were associated with increased antibiotic resistance rates across all pandemic scenarios. Introducing synergistic within-host SARS-CoV-2-pneumococcus interactions further exacerbates increasing incidence of resistant disease. When data availability is limited, mathematical modeling can help improve our understanding of the complex interactions between COVID-19 and antibiotic resistance.