Antimicrobial Resistance in the Covid-19 Era

Presentazione standard1

On 31 December 2019, health authorities in China reported to the World Health Organization (WHO) a cluster of viral pneumonia cases of unknown cause in Wuhan, Hubei, and an investigation was launched in early January 2020. On 30 January, the WHO declared the outbreak a Public Health Emergency of International Concern. The WHO recognized the spread of Covid-19 as a pandemic on 11 March 2020. As of 17 May 2020, more than 4.71 million cases of Covid-19 have been reported in more than 188 countries and territories, resulting in more than 315,000 deaths. More than 1.73 million people have recovered from the virus. The world has faced one of the most complex pandemics in recent years. Although antimicrobial resistance (AMR) hasn’t gotten our attention in the same way that SARS-CoV-2 has, antibiotic-resistant bacteria remain a growing global menace. The superbugs that cause these infections thrive in hospitals and medical facilities, putting all patients — whether they’re getting care for a minor illness or major surgery — at risk. The patients at greatest risk from superbugs are the ones who are already more vulnerable to illness from viral lung infections like influenza, severe acute respiratory syndrome (SARS), and Covid-19. The SARS-CoV-2 is no exception. Although Covid-19 is a viral infection there have been overlapping clinical and radiological features with bacterial respiratory tract infection so it is inevitable that antibiotics have been prescribed for many patients. Already, some studies have found that 1 in 7 patients hospitalized with Covid-19 has acquired a dangerous secondary bacterial infection, and 50% of patients who have died had such infections. The challenge of AMR could become an enormous force of additional sickness and death across our health system as the toll of coronavirus pneumonia stretches critical care units beyond their capacity. Even though Covid-19 is a viral illness not affected by antibiotics, early data from hospitals shows that very high proportions of patients—more than 90 percent in some cohorts—are being treated with antibiotics to cure or protect against secondary infections during respiratory illnesses or hospitalization. That’s being accompanied by an unmeasured but possibly huge number of people taking antibiotics on their own, or with the encouragement of fringe researchers, in misguided attempts to protect themselves.
The ongoing Covid-19 pandemic highlights the critical need for rapid development of vaccines and antiviral treatments to reduce the number of hospitalizations and deaths caused by this dangerous new coronavirus, SARS-CoV-2. The biopharmaceutical industry has quickly responded and at least 80 candidates are already in development. With good luck, we will eventually have some of the tools we need to fight this new global threat. But there is an even larger threat lurking behind the current outbreak, one that has already killed hundreds of thousands of people around the world and that has complicated the care of many Covid-19 patients. It is the hidden threat from antibiotic resistance — bacteria that are not killed by standard antibiotics. Unfortunately, the pipeline of drugs to manage these deadly infections is nearly dry.
For this reason we would like to focus on some important concepts.
AMR  is a natural phenomenon that occurs as microbes evolve. However, human activities have accelerated the pace at which microorganisms develop and disseminate resistance. Incorrect and inappropriate use of antibiotics and other antimicrobials, as well as poor prevention and control of infections, are contributing to the development of such resistance.
The impact of AMR worldwide is significant, both in economic terms, and clinical morbidity and mortality because it may:

  • lead to some infections becoming untreatable;
  • lead to inappropriate empirical treatment in critically ill patients where an appropriate and prompt treatment is mandatory;
  • increase length of hospital stay, morbidity, mortality and cost; and
  • make necessary alternative antimicrobials which are more toxic, less effective, or more expensive.

The World Health Organization (WHO) is now leading a global effort to address antimicrobial resistance. At the 68th World Health Assembly in May 2015, the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance. It sets out five strategic objectives:

  • to improve awareness and understanding of antimicrobial resistance;
  • to strengthen knowledge through surveillance and research;
  • to reduce the incidence of infection;
  • to optimize the use of antimicrobial agents; and
  • to develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

The global nature of antibiotic resistance calls for a global response, both in the geographic sense and across the whole range of sectors involved. In line with a One Health approach, healthcare plays a central role in preventing the emergence and spread of antimicrobial resistance.
We all have to participate in this challenge!