IRRATIONAL USE OF ANTIMICROBIAL AGENTS DURING THE COVID-19 PANDEMIC AND THE POSSIBLE EFFECTS ON THE RESISTANCE OF UROPATHOGENS IN THE CESP GROUP

Abstract

ABSTRACT 
The COVID-19 pandemic intensified the indiscriminate use of antimicrobials, exacerbating 
bacterial resistance, particularly among Enterobacterales of the CESP group (Citrobacter spp., 
Enterobacter spp., Serratia spp., and Providencia spp.), known for producing AmpC-type β
lactamases. This mechanism complicates the treatment of urinary tract infections (UTIs), which 
are common in Primary Health Care (PHC). This study analyzed the prevalence and resistance 
profile of CESP uropathogens during the Pre-Pandemic and Post-ESPIN periods (Post
Declaration of the Public Health Emergency of National Importance). A total of 801 urine 
cultures were evaluated, with Enterobacter spp. predominating (98.50% in the Pre-Pandemic 
period and 96.00% in the Post-ESPIN period). A 29.08% reduction in sensitivity to 
ciprofloxacin was observed in the Post-ESPIN period. Nitrofurantoin showed the best activity 
in both periods, while isolates sensitive to sulfamethoxazole-trimethoprim increased by 6.68% 
in the Post-ESPIN period. The results emphasize the need to understand changes in 
epidemiological patterns and bacterial resistance, highlighting the importance of updating 
clinical protocols for the safe empirical treatment of UTIs in PHC, particularly after the 
challenges posed by the pandemic.