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17. april 2020
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Antimicrobial resistance (AMR) has a role in COVID-19

Antimicrobial resistance (AMR) has a role in COVID-19

Antimicrobial resistance (AMR) is an important threat to global health1. AMR should not be overlooked despite understandable focus on the ongoing COVID-19 pandemic. An increasing body of opinion indicates that AMR may have a role in COVID-192-4.

Firstly, a significant number of the deceased COVID-19 patients have had secondary bacterial infections like is common for other several viral infections5-9. In severe viral respiratory infections, the immune system is weakened, and respiratory system exposed to other pathogens. In such cases, if a hospitalized patient is infected with resistant bacteria, consequences can be fatal. There are indications of increase in resistant bacterial infections such as MRSA in hospitals during the outbreaks of novel emerging pathogens such as previous SARS epidemics10,11. It bears further investigation if the resistant bacteria have influenced the COVID-19 situation for example in Italy, where hospitals have been shown to have significant AMR-related problems12.

Secondly, prophylactic antibiotics are often used to prevent secondary bacterial infections of the hospitalized patients as is the case also in COVID-197,8,13-15. This can significantly increase the use of antibiotics during the pandemic and silently cause the emergence of resistant bacteria, as was recently commented by Prof. Anu Kantele from University of Helsinki4.

The actual role of antimicrobial resistance in COVID-19 may be revealed in the future. However, AMR as such is an important threat to global health although it develops more silently compared to COVID-19. The fight against AMR calls for collective global actions on various levels, as has now been rapidly done in COVID-19.1, 2, 16, 17.

References
  1. WHO. Global action plan on Antimicrobial Resistance 2015. Available at WHO: Global action plan on antimicrobial resistance 2015.
  2. Kirchhelle et al. Opinion: Antibiotic Resistance Could Lead to More COVID-19 Deaths. Scientific American 2020. April 1. https://blogs.scientificamerican.com/observations/antibiotic-resistance-could-lead-to-more-covid-19-deaths/?amp, accessed 15.4.2020
  3. Aftenposten. Derfor tar koronaviruset så mange liv i Italia | Erik Martiniussen. Article in Norwegian. https://www.aftenposten.no/article/ap-awEP27.html , accessed 15.4.2020
  4. Helsingin Sanomat. Antibioottien runsas käyttö saattaa selittää Italian koronavirus­kuolemien määrää. 5.4.2020. Article in Finnish. https://www.hs.fi/tiede/art-2000006464588.html, accessed 15.4.2020
  5. Wang L et al. Coronavirus Disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020. Mar 30. doi: 10.1016/j.jinf.2020.03.019.
  6. Li et al. Clinical characteristics of 25 death cases with COVID-19: a retrospectivereview of medical records in a single medical center, Wuhan, China. Int J Infect Dis 2020. doi: https://doi.org/10.1016/j.ijid.2020.03.053
  7. Zhou et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054–62.
  8. Huang et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
  9. Centers for Disease Control and Prevention (CDC). Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1) - United States, May-August 2009. MMWR Morb Mortal Wkly Rep. 2009; 58(38):1071-4.
  10. Yap et al. Increase in methicillin-resistant Staphylococcus aureus acquisition rate and change in pathogen pattern associated with an outbreak of severe acute respiratory syndrome. Clin Infect Dis. 2004; 39(4):511-6.
  11. Chai et al. Paradoxical Increase in Methicillin-Resistant Staphylococcus aureus Acquisition Rates Despite Barrier Precautions and Increased Hand Washing Compliance during an Outbreak of Severe Acute Repiratory Syndrome. Clin Infect Dis. 2005; 40(4): 632–633.
  12. European Centre for Disease Prevention and Control. ECDC country visit to Italy to discuss antimicrobial resistance issues. Stockholm: ECDC; 2017.
  13. Cao et al. Clinical Features and Short-term Outcomes of 102 Patients with Corona Virus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020 Apr 2. doi: 10.1093/cid/ciaa243.
  14. Lupia et al. 2019 novel coronavirus (2019-nCoV) outbreak: A new challenge. J Glob Antimicrob Resist. 2020 Mar 7; 21:22-27. doi: 10.1016/j.jgar.2020.02.021.
  15. Wang et al. Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020 Mar 16. doi: 10.1093/cid/ciaa272.
  16. WHO. Strategic preparedness and response plan for the new coronavirus14.4.2020. https://www.who.int/publications-detail/covid-19-strategy-update-13-april-2020, Accessed 15.4.2020
  17. PEW. The Invaluable Role of Antibiotics—in a Pandemic and Beyond, 15.4.2020. https://www.pewtrusts.org/en/research-and-analysis/articles/2020/04/15/the-invaluable-role-of-antibiotics-in-a-pandemic-and-beyond?amp=1&__twitter_impression=true, Accessed 17.4.2020
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