This scoping review aimed to explore the prevalence and patterns of global antibiotic use and bacterial infection in COVID-19 patients from studies published between June 2020 and March 2021. This review was reported in line with the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews, and the protocol is registered with the Open Science Framework. Compared with our previously-published review of the period (December 2019–June 2020), the antibiotic prescribing rate for COVID-19 patients (June 2020–March 2021) was found to have declined overall (82.3% vs. 39.7%), for mild and moderate patients (75.1% vs. 15.5%), and for severe and critical patients (75.3% vs. 48.3%). The seven most frequently prescribed antibiotics in COVID-19 patients were all on the “Watch” list of the WHO AWaRe antibiotics classification. The overall reported bacterial infection rate in COVID-19 patients was 10.5%, and the most frequently reported resistant pathogen in COVID-19 patients was Staphylococcus aureus, followed by Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. There is an urgent need to establish comprehensive and consistent guidelines to assist clinicians in selecting appropriate antibiotics for COVID-19 patients when needed. The resistance data on the most frequently used antibiotics for COVID-19 patients for certain resistant pathogens should be closely monitored.

Within the One Health framework applied to global health issues including antimicrobial resistance (AMR) and zoonoses, ecological linkages between animals, wastes, soil, water, and humans are increasingly being interpreted through the lens of pathogenic transmission. This framing problematises waste practices and cross-species contact in many parts of the Global South, where rural livelihoods are often closely integrated with farm animals and organic materials. In this study, we use metabolic relations as an analytical tool to understand One Health linkages in AMR ecologies, moving beyond transmission pathways. We examine the entangled and often ambivalent relationships surrounding waste, food and environmental health in rural China, where interactions involving these elements are associated with both wellness and harm. Drawing on ethnographic research into everyday agricultural practices and waste management, we explore the tensions between positioning organic wastes as hazardous and metabolic dependencies on them for livelihoods. We show how co-existing governance imperatives for separation and circulation in waste treatment bring into focus the collision between long-standing integrated farming practices and the hazardous inputs of industrial farming. We further illuminate the lived experiences of ambivalent metabolic relations, wherein local communities are caught between material dependencies on subsistence agriculture and exposure to potential toxic fallout from urban-oriented commercial production. We argue that One Health responses to antimicrobial resistance must transcend a narrow focus on hygiene and biosecurity to engage with the latent political-economic configurations of uneven exposure.