Antimicrobial Resistance (AMR) presents a pressing public health challenge globally which
has been compounded by the COVID-19 pandemic. Elucidation of the impact of the pandemic
on AMR evolution using population-level data that integrates clinical, laboratory and
prescription data remains lacking. Data was extracted from the centralized electronic platform
which captures the health records of 60,551 patients with a confirmed infection across
the network of public healthcare facilities in Dubai, United Arab Emirates. For all inpatients
and outpatients diagnosed with bacterial infection between 01/01/2017 and 31/05/2022,
structured and unstructured Electronic Health Record data, microbiological laboratory data
including antibiogram, molecular typing and COVID-19 testing information as well as antibiotic
prescribing data were extracted curated and linked. Various analytical methods, including
time-series analysis, natural language processing (NLP) and unsupervised clustering
algorithms, were employed to investigate the trends of antimicrobial usage and resistance
over time, assess the impact of prescription practices on resistance rates, and explore the
effects of COVID-19 on antimicrobial usage and resistance. Our findings identified a significant
impact of COVID-19 on antimicrobial prescription practices, with short-term and longlasting
over-prescription of these drugs. Resistance to antimicrobials increased the odds
ratio of all mortality to an average of 2.18 (95% CI: 1.87–2.49) for the most commonly prescribed
antimicrobials. Moreover, the effects of antimicrobial prescription practices on resistance
were observed within one week of initiation. Significant trends in antimicrobial
resistance, exhibiting fluctuations for various drugs and organisms, with an overall increasing
trend in resistance levels, particularly post-COVID-19 were identified. This study
provides a population-level insight into the evolution of AMR in the context of COVID-19
pandemic. The findings emphasize the impact of COVID-19 on the AMR crisis, which
remained evident even two years after the onset of the pandemic. This underscores the
necessity for enhanced antimicrobial stewardship to address the evolution of AMR.
