Antimicrobial resistance: A challenge awaiting the post-COVID-19 era

Abstract

Microbe exposure to pharmaceutical and non-pharmaceutical agents plays a role in the development of antibiotic resistance. The risks and consequences associated with extensive disinfectant use during the COVID-19 pandemic remain unclear. Some disinfectants, like sanitizers, contain genotoxic chemicals that damage microbial DNA, like phenol and hydrogen peroxide. This damage activates error-prone DNA repair enzymes, which can lead to mutations that induce antimicrobial resistance. Public health priority programs that have faced drug-resistance challenges associated with diseases, such as tuberculosis, HIV, and malaria, have given less attention to risks attributable to the COVID-19 pandemic. Pathogen-specific programs, like the directly observed treatment strategy, which were designed to fight resistance against anti-tuberculosis drugs, have currently become impractical, because COVID-19 restrictions have limited in-person visits to health institutions. Here, we summarized the key findings of studies on the current state of antimicrobial resistance development, from the perspective of current disinfectant use. Additionally, we provided a brief overview of the consequences of restricted access to health services, due to COVID-19 precautions, and their implications on drug resistance development.

Antibiotic Heteroresistance in Klebsiella pneumoniae

“…It has been recently demonstrated that human contact restrictions and other strategies to prevent SARS-CoV-2 transmission during the COVID-19 pandemic have limited the spread of K. pneumoniae and other ESKAPE pathogens [ 87 , 88 ]. However, the extensive use of disinfectants and increased administration of antibiotics to prevent bacterial co-infections during the COVID-19 pandemic may enhance the emergence and spread of drug resistance [ 89 , 90 , 91 ]. Several studies have indicated that the prevalence of carbapenem-resistant K. pneumoniae co-infection in COVID-19 patients may reach more than 50% of cases [ 92 , 93 ].…”

Multidrug Resistance (MDR): A Widespread Phenomenon in Pharmacological Therapies

“…The high antibiotic utilization may have contributed to the increase in MDRGNs among COVID-19 patients, together with other factors (altered infection control practices, critical illness and prolonged hospital stay of COVID-19 patients) [ 114 ]. Ukuhor (2021) reported that various types of bacterial and fungal infections occur in patients with COVID-19 with some resistant to antimicrobials that are associated with significantly worse outcomes and deaths [ 115 ]. In another study of Lobie et al (2021) [ 115 ] is reported that some disinfectants, such as sanitizers, contain genotoxic chemicals that damage microbial DNA, activating error-prone DNA repair enzymes, which can lead to mutations that induce antimicrobial resistance.…”

“…Ukuhor (2021) reported that various types of bacterial and fungal infections occur in patients with COVID-19 with some resistant to antimicrobials that are associated with significantly worse outcomes and deaths [ 115 ]. In another study of Lobie et al (2021) [ 115 ] is reported that some disinfectants, such as sanitizers, contain genotoxic chemicals that damage microbial DNA, activating error-prone DNA repair enzymes, which can lead to mutations that induce antimicrobial resistance. On the other hand, it is fair to report a retrospective study that demonstrated a reduction in MDR bacterial infections during the COVID-19 pandemic.…”

Blood culture utilization and epidemiology of antimicrobial-resistant bloodstream infections before and during the COVID-19 pandemic in the Indonesian national referral hospital

“…Antimicrobial-resistant (AMR) bacterial infections pose an emerging health problem globally, with a disproportionate impact in low and middle-income countries (LMICs) [ 1 , 2 ]. The COVID-19 pandemic has potentially escalated this problem due to increased use of antibiotics in patients hospitalized with COVID-19 [ 3 , 4 ].…”