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Spike in antibiotic use during coronavirus pandemic could lead to more resistant bacterial infections: Experts

Scientists will investigate just how widely antibiotics are being given to COVID-19 patients and how often they have secondary infections that warrant antibiotic use
UPDATED APR 18, 2020
(Getty Images)
(Getty Images)

Complications from COVID-19 could potentially fuel antibiotic resistance, and lead to more resistant bacterial infections, warn scientists. While SARS-CoV-2, the pathogen responsible for COVID-19, is a virus, the disease can lead to conditions that require antibiotic treatment, including bacterial pneumonia, say experts. 

Antibiotic resistance is a serious worldwide threat to public health, says the WHO. Experts say in severe cases, it can be difficult to determine if pneumonia in a COVID-19 patient is viral or bacterial in nature, and the severity of the condition may require urgent action. The incorrect administration of antibiotics is secondary to the main goal of saving lives, but some experts are highlighting this as a growing concern. A myriad of complex factors could impact antimicrobial resistance (AMR) in the US and around the world, they caution. 

“The current COVID-19 pandemic threatens to further weaken the already crumbling antibiotic infrastructure. During the 2009 H1N1 influenza pandemic, environmental microbiologists warned that the spike in antibiotic use would lead to more resistant bacterial infections. The same thing is now happening with COVID-19 but on an arguably much vaster scale. Resistance to some of the antibiotics we depend on will likely be an inevitable conclusion,” write researchers in Scientific American.

Studies also indicate that antibiotic use is on the rise. An analysis of 1,099 patients from 552 hospitals across China shows that a majority of the patients (58%) received intravenous antibiotic therapy. The average duration of hospitalization was 12 days. During hospital admission, most of the patients received a diagnosis of pneumonia from a physician (91.1%), followed by acute respiratory distress syndrome or ARDS (3.4%) and shock (1.1%). Patients with severe disease had a higher incidence of physician-diagnosed pneumonia than those with nonsevere disease (99.4% versus 89.5%), says the study published in The New England Journal of Medicine (NEJM).

Experts say in severe cases, it can be difficult to determine if pneumonia in a COVID-19 patient is viral or bacterial in nature, and the severity of the condition may require urgent action. (Getty Images)

In another study, researchers found that 15% of COVID-19 patients in China acquired bacterial infections. The analysis included 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital), of whom 137 were discharged and 54 died in hospital. The most common symptoms on admission were fever and cough. “Lymphocytopenia (abnormally low level of lymphocytes in the blood) occurred in 77 (40%) patients. 181 (95%) patients received antibiotics and 41 (21%) received antivirals,” says the study published in The Lancet. 

The study shows that half of those who died had a secondary infection. Ventilator-associated pneumonia occurred in ten (31%) of 32 patients requiring invasive mechanical ventilation. The frequency of complications was higher in non-survivors than survivors. “50% of those who died tested positive for secondary infections compared to only one of the 137 survivors. In this situation, antibiotics form a crucial second line of defense. Many studies indicate that nearly all severe COVID-19 patients will receive antibiotics,” say experts in Scientific American.

While the US Centers for Disease Control and Prevention requires hospitals to report their antibiotic use and the rates of infections acquired, Priya Nori, who runs Montefiore Medical Center’s antibiotic stewardship program, and other doctors told Science that compliance has fallen off amid the coronavirus pandemic. 

Over 2,256,840 cases have been reported globally as of April 18, and over 154,300 have died during the coronavirus pandemic. Medical experts worry that the surge of COVID-19 patients could ultimately lead to a surge in antibiotic-resistant bacteria. Acordingly, the US Department of Defense (DOD) is bringing a together group of at least 10 medical centers to study “secondary bacterial and fungal infections in these patients and the antibiotics being used to prevent them,” reports Science. “The study will investigate just how widely antibiotics are being given to COVID-19 patients, and how often they have secondary infections that warrant antibiotic use. The results should help experts develop guidelines for when and how doctors should prescribe antibiotics to COVID-19 patients, as well as provide a data set on potentially thousands of patients to help researchers better understand how infections spread in hospitals and why bacterial and viral infections are linked,” says the report. 

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