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Parallel pandemics: COVID-19 and the lessons for Antimicrobial Resistance

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Article published on September 30, 2021 on the British Society for Antimicrobial Chemotherapy

While the COVID-19 pandemic has understandably hogged the headlines for the last few years, there is another, ‘slow-motion’ pandemic taking place at the same time: Antimicrobial Resistance (AMR). In this post, Dr Louise Sweeney, Consultant Medical Microbiologist, Liverpool, explores what COVID-19 can teach us when it comes to treating all infectious diseases…

It’s been nearly two years since reports of a mystery illness spreading through the population of Wuhan first emerged, since wearing masks became a normal part of everyday life, and terms like ‘RO number’ and ‘PCR test’ entered the general vernacular. Two years, and SARS-CoV-2 is still very much with us and likely to be so for quite some time to come.

As difficult as this period has been, perhaps one of the silver linings has been the enormous spotlight cast on the devastating effects that transmissible agents of infection can have, agents for which there are no simple cures, no magical antimicrobials that will kill them off and make us all better. Because this is the perception that much of the general public and even some clinical colleagues have. That antimicrobials are a magic bullet. That infection can always be treated.

Now of course SARS-CoV-2 is a virus, and there are few viruses for which effective antiviral treatments exist. Supportive treatment plus immune modulation are often the only management options available, but nevertheless, the messages of this pandemic, the global wake-up call it has caused, are also applicable to other causes of infection particularly in the context of Antimicrobial Resistance (AMR).

For AMR is itself a global health emergency, albeit a far quieter one1. Those of us who work, study or have an interest in infection know that AMR causes significant morbidity and mortality, with published data on the global effects of, for example, extensively drug-resistant or multidrug-resistant tuberculosis and increasingly drug-resistant gonorrhoea. However even locally, day-to-day, the effects of resistance can be seen. How many of us working in Microbiology have noticed an increasing number of urine culture and sensitivity reports featuring more of the letter ‘R’ than ‘S’? How many are having to recommend admission to hospital or use Outpatient Parenteral Therapy (OPAT) to treat UTI in community patients because of a lack of oral treatment options?

Unfortunately for us, the effects of AMR are not always as obvious to everyone as those of COVID. When a clinician prescribes antibiotics ‘just in case’ because of the perception of this as a low harm intervention, the effects of that one action on that individual patient and on patient populations are not immediate and not always clearly visible to all.

So, what can we do?

Well, the continuing spotlight on COVID should actually allow us to opportunistically bathe AMR in its glow. The pandemic has had a significant effect both on AMR and antimicrobial stewardship2-5, and many of the messages and learning points from the pandemic can be extrapolated to the approach to AMR, such as the importance of infection control; the role of rapid diagnostics; the need for research, investment and innovation; and the clarity of information and education provided to both professionals and the general public.

So let us refocus, renew our efforts, perhaps even come up with new approaches to tackling this other big pandemic. Let’s share ideas, learning, and experience. Come help shine a spotlight on AMR and join us on October 14th for the hybrid BSAC Into Clinical Practice: Meeting the Challenges of Gram-Negative Infection Management conference. We have a fantastic programme with excellent speakers covering a range of topics from EUCAST, gonorrhoea, animals & the environment to the exotic & imported (Burkholderia pseudomallei) and our new day-to-day (the impact of COVID-19 on Gram-negative resistance).  This is an exciting opportunity to meet and discuss and encourage and support after a very long time apart. I hope to see you there.

Interested in exploring this topic further? Dr Louise Sweeney is speaking at our upcoming conference: Into Clinical Practice: Meeting the challenges of Gram-negative infection management, 14 October 2021, online and in-person at the Royal College of Physicians, London. Find out more and book your place here.

References

  1. The Interagency Coordination Group on Antimicrobial Resistance (IACG). No time to wait: securing the future from drug-resistant infections. 2019.
  2. Rawson TM, Ming D, Ahmad R, Moore LSP, Holmes AH. Antimicrobial use, drug-resistant infections and COVID-19. Nat Rev Microbiol 2020: :18:409-410 doi:10.1038/s41579-020-0395- y.
  3. Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020. ciaa530 doi:10.1093/cid/ciaa530
  4. Miranda A, Silva V, Capita R et al. Implications of antibiotics use during the COVID-19 pandemic: past, present and future. Journal of Antimicrobial Chemotherapy, August 2020 doi:10.1093/jac/dkaa350
  5. Ashiru-Oredope D, Kerr F, Hughes S et al.   Assessing the impact of COVID-19 on antimicrobial stewardship activities/programs in the United Kingdom Antibiotics (Basel) 2021; 10: 110