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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 29-30

Antimicrobial resistance in COVID-19: Pandemic within pandemic


Department of Infection Control, Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow, Uttar Pradesh, India

Date of Submission07-Apr-2022
Date of Acceptance29-May-2022
Date of Web Publication12-Nov-2022

Correspondence Address:
Dr. Areena Hoda Siddiqui
Department of Lab Medicine, Sahara Hospital, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_11_22

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How to cite this article:
Siddiqui AH. Antimicrobial resistance in COVID-19: Pandemic within pandemic. J Patient Saf Infect Control 2022;10:29-30

How to cite this URL:
Siddiqui AH. Antimicrobial resistance in COVID-19: Pandemic within pandemic. J Patient Saf Infect Control [serial online] 2022 [cited 2022 Dec 6];10:29-30. Available from: https://www.jpsiconline.com/text.asp?2022/10/1/29/361002



Sir,

Antimicrobial resistance (AMR) is defined as the ability of the microorganisms, for example, bacteria, viruses, fungus and parasites to evade themselves from antimicrobial (antibacterial, antiviral, antifungal, and antiparasitic) agents. This aids protection to the microbes from medicine and persistence of infection in the patients. It leads to increase the length of stay in hospitals, increase the cost of the treatment to the patients and increase mortality and morbidity.[1]

COVID-19 and AMR have many similarities. Both are recognised as a global threat. Both have an impact on global economy. Both have affected people around the globe expanding themselves to clinics and communities.

Presently, there are 3.47 crore people affected by COVID-19 globally and 4.77 lakh mortality. AMR has been associated with mortality and if it is not controlled it will become a major contributor of death. It is forecasted by world economists that there will be 10 million deaths due to AMR per year by 2050 and an accumulated cost to the global economy of $100 trillion.[2] It is also important to mention that with proper measures world will be able to manage COVID-19 in time frame whereas AMR if reached to communities would be impossible to manage.

There is a dearth of antimicrobial development and pharmaceuticals are not investing in new drug research.

AMR can occur naturally through genetic changes; however, the three main reasons are overuse, misuse and underuse of these antimicrobials.

This overuse, misuse of antimicrobial was recently encountered in the COVID-19 pandemic. The patients admitted to the COVID-19 unit were prescribed antibiotics which were not required. There is limited data available for secondary bacterial infections (SBI) during COVID-19. In a report, it was mentioned that only 10% of COVID-19 patients developed SBI.[3] However, despite low bacterial infection antibiotic prescription was found in 45%–70% of cases.[4]

With the emergence of moulds and yeasts in post-COVID-19 era, there is an increase in empirical antifungal prescription too. Increase in antifungals and their inappropriate use can lead to resistance in antifungals. Data related to antifungal usage in COVID patient are limited or not available.

Outside health-care organisation, the measures aimed at reducing transmission of COVID-19 including handwashing and frequent usage of hand rubs and disinfection of surroundings in the community by chemicals could have a negative impact on the environment and microbes. The presence of biocide in wastewater treatment plants may contribute to AMR in the environment. It can influence the ecosystem as well. Regular use of hand rubs and disinfectants will replace the normal flora and will lead to encroachment of multidrug-resistant organisms on skin and surroundings.[1]

Increase antibiotic consumption during COVID-19 either for treatment of SBI or as a potential therapy for COVID-19 contributed to selection pressure and AMR.

Besides the above, the general population is contributing to AMR. The WHO reported the usage of antibiotics among general public as antiviral in pre-COVID-19 era.[5] This pandemic has also seen prescription of antibiotics either from the doctors or self-medication among community.

Increase in AMR necessitates the need to raise the standards of knowledge not only among health-care workers but to the general public. Social media and digital platforms can help stakeholders to create awareness among society.

AMR has become global threat. Single intervention might not be useful in controlling infection. Coordinated action is required to minimise the emergence as well as the spread of AMR. Strong antibiotic stewardship and antifungal stewardship in association with diagnostic stewardship are needed to reduce AMR. Commitment from the treating consultants to comply with the antimicrobial policy and reviewing the treatment protocols, de-escalation of antibiotics is warranted. Infection control measures must be implemented to combat the spread of infections.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Murray AK. The novel coronavirus COVID-19 outbreak: Global implications for antimicrobial resistance. Front Microbiol 2020;11:1020.  Back to cited text no. 1
    
2.
WHO. New Report Calls for Urgent Action to Avert Antimicrobial Resistance Crisis. Available from: https://www.who.int/news/item/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis. [Last accessed on 2022 Jan 01].  Back to cited text no. 2
    
3.
Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 2020;55:105924.  Back to cited text no. 3
    
4.
Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: Retrospective case series. BMJ 2020;368:m606.  Back to cited text no. 4
    
5.
WHO. Antibiotic Resistance: Multi-Country Public Awareness Survey. Geneva: WHO; 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/194460/9789241509817_eng.pdf; jsessionid=1CE653DEFA6FD52A298091F0633B9E87?sequence=1. [Last accessed on 2022 Jan 13].  Back to cited text no. 5
    




 

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