COVID-19 and Antimicrobial Resistance: A Review

Abstract

As the world continues to respond to the coronavirus pandemic (COVID-19), there is a larger hidden threat of antimicrobial resistance (AMR) lurking behind. AMR remains worrisome in that the pathogens causing resistant infections to thrive in hospitals and medical facilities, putting all patients at risk, irrespective of the severity of their medical conditions, further compounding the management of COVID-19. This study aims to provide overview of early findings on COVID-19 and AMR as well as to provide recommendations and lesson learned toward improving antimicrobial stewardship. We conducted a rapid narrative review of published articles by searching PubMed and Google Scholar on COVID-19 and Antimicrobial Resistance with predetermined keywords. Secondary bacterial infections play crucial roles in mortality and morbidity associated with COVID-19. Research has shown that a minority of COVID-19 patients need antibiotics to treat secondary bacterial infections. Current evidence reiterates the need not to give antibiotic therapy or prophylaxis to patients with mild COVID-19 or to patients with suspected or confirmed moderate COVID-19 illness unless it is indicated. The pandemic has also brought to the fore the deficiencies in health systems around the world. This comes with a lot of lessons, one of which is that despite the advances in medicine; we remain incredibly vulnerable to infections with limited or no standard therapies. This is worth thinking in the context of AMR, as the resistant pathogens are evolving and leading us to the era of untreatable infections. There is a necessity for continuous research into understanding and controlling infectious agents, as well as the development of newer functional antimicrobials and the need to strengthen the antimicrobial stewardship programs.

Pilot Study on the Current Management of Children with COVID-19 In Hospitals in Bangladesh; Findings and Implications

“…In addition, the high use of vitamins and zinc is in line with current national guidelines in Bangladesh (Box 1). However, there were concerns with the high empiric use of antibiotics (Table 2) despite, as mentioned, only a limited number of patients across ages have concomitant fungal or bacterial infections [62][63][64][65][66][67][68][69] . In addition, concerns with overuse are documented in the current national guidelines (Box 1).…”

“…Having said this, we are aware of the high use of antimicrobials in hospitals including intensive care units in treating patients with COVID-19 despite only a limited number of patients have concomitant fungal or bacterial infections [62][63][64][65][66][67][68][69] . This includes hospitals in Bangladesh 70,71 .…”

“…This includes hospitals in Bangladesh 70,71 . As a result, potentially increasing rates of antimicrobial resistance (AMR) with its associated increase in morbidity, mortality and costs 66,[72][73][74][75][76][77] . The instigation of antimicrobial stewardship programmes (ASPs) should help to address key concerns as these programmes have reduced inappropriate antibiotic utilisation among a number of LMICs 72,73,78,79 , with educational and other initiatives also reducing inappropriate antibiotic prescribing to prevent surgical site infections among LMICs 72,80 .…”

Evaluation of Antibacterial and Antiviral Drug Effectiveness in COVID-19 Therapy: A Data-Driven Retrospective Approach

“…Antibiotic selection pressure [ 34 , 35 ] would increase the incidence of multidrug-resistant organisms. Thirteen bacteria have been identified as causing a secondary infection to SARS-CoV-2, where it may lead to increased mortality and morbidity for COVID-19 patients [ 36 ].…”

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

“…The ongoing Coronavirus Disease 2019 (COVID-19) pandemic and the lack of an effective therapeutic protocol could further contribute to AMR [ 12 ]. Indeed, with the massive, and sometimes inappropriate, use of antibiotics to treat COVID-19 and flu symptoms, AMR threat remains significant [ 13 ]. However, the relationship between COVID-19 and AMR is not clear.…”