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Coronavirus meets antimicrobial resistance
Antimicrobials are a boon to mankind and have contributed significantly in medical advancements. This been said, the use of excess or at times lower dosage of antimicrobials give the microbes a chance to adapt and emerge stronger thus leading to antimicrobial resistance (AMR). This restricts our intension of arresting the microbial growth and hence infection. During the ongoing COVID-19 crisis, it has become all the more necessary to address this global problem of AMR in the changing healthcare scenario.
How can COVID-19 have an impact on increase in AMR?
The reasons why the pandemic has impacted the already grave problem of AMR are as follows:
The pandemic spread of coronavirus last year put a burden on the healthcare system and the economies. The viral pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) resembles bacterial pneumonia in terms of symptoms. As a result, the antimicrobials, analgesics, muscle relaxants, anaesthetics used for treating “pneumonia-like symptoms” were widely used for treating COVID-19 infections causing temporary shortages of medicines (Pelfrene et al., 2021).
In addition to this the patients diagnosed with mild COVID-19 symptoms were and still are often hospitalised and prescribed broad-spectrum antibiotics. A review published last year on hospitalized COVID-19 patients stated that out of the 72% patients that received antibiotic treatment, only 8% patients had bacterial or fungal co-infections. A report by World Health Organisation (WHO) states that azithromycin in combination with hydroxychloroquine was generally prescribed even though this treatment was not approved for use outside of COVID-19 clinical trials (Getahun et al., 2020).
Apart from this, the increased hospital admissions to a point that the healthcare system collapses, further increase the risk of health-care-associated infections. The overwhelmed hospitals become the centre for transmission of multidrug-resistant organisms, which leads to increased antimicrobial use and therefore AMR (Knight et al., 2021).
The latest update of WHO’s points at the clinical management of COVID-19 and doesn’t advocate antibiotic medical aid or prevention for patients with gentle or moderate COVID-19 unless signs and symptoms of a bacterial infection exist. This suggests that the utilization of empiric antibiotic treatment for patients with suspected or confirmed severe COVID-19, supported clinical judgement considering patient host factors and native medical specialty, together with daily assessments for decrease, is usually recommended (Getahun et al., 2020)
Other factors that could be contributing to an increased risk of nosocomial infection are: 1) shortages of personal protective equipment (PPE) 2) shortage of medical staff due to disease, self-quarantine and increased demand often causing stress 3) deployment of inexperienced staff with only basic training.
How can the spread of resistance be avoided during the pandemic?
To start with, the antibiotics used for treatment need to be used responsibly and sparingly, according to adequate antimicrobial stewardship measures (AMS). Empirical antibiotherapy should only be administered to those patients who have a high chance of acquiring bacterial infection. This should be verified by performing simple antimicrobial susceptibility testing assays after isolation of the infection causing organisms. The prescriptions recommending use of antibiotics should be rapidly re-evaluated and altered according to progressing microbiological results.
It is extremely important to raise awareness about the AMR challenges and how each one should work towards combatting resistance. Now more than ever the development of rapid diagnostics, vaccines and new antimicrobial agents, including alternative therapeutics (such as bacteriophages, monoclonal antibodies, virulence factor modulating products) need to be incentivized.
Vaccines are a key tool to prevent infections, and hence antibiotic use and associated resistance. It is indeed the hard work of the researchers in the past year that is paying off. Even after the numerous lockdowns and the hurdles caused during the tiring work hours, our scientific community has developed so many vaccines from scratch!
AMR research
AMR is a global threat and cannot be neglected in pandemic times. Researchers should be supported to continue the AMR research work. We must also build on the push that the COVID-19 pandemic has given to making science even more open, with results shared rapidly across scientific groups and institutes. With my ViBrANT colleagues, we are trying to advocate the need for understanding the importance of AMR research while designing novel strategies to combat antimicrobial resistance- one pathogen at a time 🙂