Connection Between COVID-19 and AMR

Antimicrobial Resistance and COVID-19: Intersections and Implications, an in-depth article published by eLife, explores the complex relationship between two significant threats to public health and the healthcare industry: antimicrobial resistance and COVID-19.

Here, we discuss the key takeaways from the article and explore the role of BIOFIRE^® syndromic testing solutions.

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 in 2021, "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.

How has the COVID-19 pandemic impacted antimicrobial stewardship?

Antimicrobial stewardship programs in healthcare institutions can help reduce the incidence of healthcare-acquired infections that are resistant to antimicrobials through the avoidance of antibiotic misuse, enhanced infection protection, personal protective equipment usage, and targeted hygiene. However, the burden of COVID-19 on healthcare systems was not limited to diagnosing and treating SARS-CoV-2 infections. Pandemic-related staffing and supply shortages also negatively impacted antimicrobial stewardship programs.

Amidst the extreme burden to healthcare providers and systems, COVID-19 patients who were hospitalized for long periods of time became increasingly at risk of developing a secondary healthcare-acquired infection, many of which are antibiotic resistant. For that reason, patients with COVID-19 ultimately "required multiple courses of broad-spectrum antibiotics, mechanical ventilation, other organ support, and/or invasive devices. This increases exposure to, and risk of, infections with hospital-associated pathogens that are often highly resistant such as methicillin-resistant Staphylococcus aureus (MRSA), P. aeruginosa, Candida auris, and Acinetobacter baumannii."

Learn more about the important role of antimicrobial stewardship in emergency preparedness efforts.

What is the role of diagnostics in antimicrobial stewardship amidst the COVID-19 pandemic?

SARS-CoV-2 remains top-of-mind for physicians and patients alike at the onset of every respiratory season, but several respiratory pathogens cause similar symptoms and can be hard to distinguish based on clinical presentation alone.

Syndromic testing is a symptom-driven approach to infectious disease diagnostics that empowers healthcare providers to get actionable answers faster. The BIOFIRE^® FILMARRAY^® System performs syndromic tests that combine the ability to detect several possible pathogens into a single test—with results in about an hour. Each of The BIOFIRE^® FILMARRAY^® Panels identifies a comprehensive menu of targets that cause a specific disease syndrome, such as upper respiratory infections, pneumonia, gastroenteritis, meningitis/encephalitis, and bloodstream infections.

Additionally, the BIOFIRE System targets antimicrobial resistance genes commonly associated with pneumonia and bloodstream infections. Getting results in about an hour on a broad grouping of pathogens and relevant antimicrobial resistance markers can empower physicians to optimize therapy sooner, identify co-infections, and potentially avoid unnecessary antibIOtic prescriptions.

Explore SARS-CoV-2 solutions.

What's next in the fight against antimicrobial resistance?

The impacts of COVID-19—including future outbreaks and lockdowns—are likely to impact public health efforts, economic recovery, and antimicrobial stewardship for years. The separate threats, and combination of, COVID-19 and antimicrobial resistance must be met with further research, emergency preparedness, and infrastructure improvements.

The article states, "Our global public health agenda will have to support the management of problems related to COVID-19 in conjunction with existing challenges such as AMR for the foreseeable future." Researchers should prioritize the enhancement of diagnostic stewardship and the creation of new, effective antimicrobial therapies to replace ones impacted by antimicrobial resistance.

Health systems should invest in emergency preparedness and antimicrobial stewardship programs and prioritize the availability of effective and affordable treatments for common, ongoing health concerns their patients face. Clinicians should consider diagnostic testing that helps them optimize therapy and avoid the inappropriate and unnecessary use of antibiotics. Communities, especially those with high population density, should prioritize public health prevention strategies and improving sanitation and water supply infrastructure.

The COVID-19 pandemic already has—and will continue to—impact the escalation of antimicrobial resistance and the implementation of antimicrobial stewardship programs around the world. These unprecedented challenges have increased the urgency of the threat of antimicrobial resistance to public health and healthcare systems and highlighted the need for better diagnostic and antimicrobial stewardship.

References:

Knight GM, et al. Antimicrobial resistance and COVID-19: Intersections and implications. eLife 2021;10:e64139.