Managing the Risks of Antimicrobial Resistance Concurrently with COVID-19

By the bioMérieux Connection Editors

SARS-CoV-2 is a respiratory virus, and like other respiratory viruses, can lead to secondary bacterial infections.  A retrospective study of COVID-19 patients from two hospitals in Wuhan, China, showed that, of patients who did not survive, half had experienced a secondary infection.  While the study involved only 191 patients, it represents an early look at outcomes among patients who survived and those who did not. It is also worth noting that during the H1N1 pandemic in 2009, between 29% and 55% of the nearly 300,000 deaths were actually caused by secondary bacterial pneumonia.

Patients at the greatest risk for secondary infections, particularly infections that are resistant to first-line antibiotics, include people who are already vulnerable due to other conditions and diseases—like COVID-19. Because of that, antimicrobial resistance poses a significant additional threat, especially as healthcare systems become overburdened.

Concerns are especially salient for older COVID-19 patients—after age 50, fatality rates begin to climb dramatically.  Worldwide, patients under age 50 have had mortality rates between 0.20% and 0.40%, while the mortality rate for patients age 50-59 is 1.30%, 60-69 is 3.60%, 70-79 is 8.00%, and 80+ is 14.80%.  Patients with comorbidities such as cancer, hypertension, chronic respiratory disease, diabetes, or cardiovascular disease, are also at increased risk with COVID-19.  In addition, these groups are also at increased risk for an antibiotic-resistant infection.

In the United States alone, the CDC estimates that there are 2.8 million antibiotic resistant infections each year, leading to more than 35,000 deaths.  Many of those infections are healthcare-associated infections (HAIs), affecting patients who are receiving treatment for other conditions.  This makes the surge of patients into hospitals due to COVID-19 all the more concerning.

How Hospital Antimicrobial Stewardship Programs Can Help

Antimicrobial Stewardship Programs (ASPs) are a valuable part of hospital safety and quality, and the teams that manage them often include pharmacists and physicians with advanced infectious diseases training. This positions ASPs, especially those that are already integrated with hospital infection prevention programs, to support response and planning for emerging pathogens like SARS-CoV-2.  If infection prevention programs and ASPs are not already integrated, the response to COVID-19 presents an opportunity to do so.

ASPs typically coordinate extensively with microbiology laboratories, helping facilitate early identification and effective of infections, including upper respiratory infections identified through rapid diagnostics, such as multiplex PCR, and judicious utilization of antimicrobial therapies.  They can do the same for COVID-19, and they can help monitor patients for secondary bacterial pneumonia and Acute Respiratory Distress Syndrome (ARDS) to guide treatment.

ASP teams can also help develop local treatment protocols, monitor and manage any drug shortages, and assist frontline physicians with expanded access investigational new drug applications (eINDs) and surrounding review procedures. The COVID-19 pandemic calls for a coordinated, multidisciplinary approach to patient care and infection control to help stem the spread of the virus and to identify and treat secondary bacterial infections.  ASPs already play a critical role in reducing the spread of antimicrobial resistance—they can make an impact for COVID-19 patients too.

Opinions expressed in this article are not necessarily those of bioMérieux, Inc.

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