What is the relationship between antimicrobial resistance and COVID-19?
COVID-19 and antimicrobial resistance are two separate and seemingly unrelated threats—the COVID-19 pandemic is a new and urgent viral threat, while antimicrobial resistance has been gradually escalating for decades and is most often associated with antibiotic prescriptions. However, the relationship between AMR and COVID-19 is both strong and complex.
eLife’s review reports that “as many as 70% of patients with COVID-19 receive antimicrobials” while being treated for the illness. When used to directly treat a SARS-CoV-2 infection, even if successful, the use of these antimicrobial medications can contribute to growing resistance in other co-infecting or colonizing pathogens. “Clinicians are therefore challenged with competing priorities: prescribing a broad enough spectrum antimicrobial to ensure the organism is sensitive, while at the same time avoiding the unnecessary use of antimicrobials, particularly those of last resort, when a more commonly used or narrower-spectrum antimicrobial would suffice.”
It is also possible for patients with COVID-19 to develop a secondary bacterial co-infection. Although the occurrence of such infections is relatively low, the risk factors of bacterial pneumonia and other co-infections can be high, which is why empiric antibiotics have frequently been prescribed to patients with severe COVID-19 infection.
Patients with COVID-19 can present with non-specific symptoms that are mistaken for other disease states and thus be prescribed antibiotics inappropriately. Additionally, due to the unprecedented strains of the pandemic on healthcare systems, travel restrictions, closures, and supply chain disruptions around the world, presumptive antibiotics are being prescribed for a variety of conditions more often than usual. As these changes and effects continue, their combined impacts may accelerate the global spread of antimicrobial resistance.