DISINFACTS | Issue 3/2020

8 KNOWLEDGE Sources: 1 van Duin D, Barlow G, Nathwani D. The impact of the COVID-19 pandemic on antimicrobial resistance: a debate, JAC Antimicrob Resist 2020; doi: 10.1093/jacamr/dlaa053 2 Rawson TM, Moore LSP, Zhu N et al. Bacterial and fungal co-infection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020; doi: 10.1093/cid/ ciaa530; zitiert in [1] 3 Clancy CJ, Buehrle DJ, Nguyen MH. PRO: the COVID-19 pandemic will result in increased antimicrobial resistance rates. JAC Antimicrob Resist 2020; doi:10.1093/jacamr/dlaa049 4 Collignon P, Beggs JJ. CON: COVID-19 will NOT result in increased AMR prevalence. JAC Antimicrob Resist 2020; doi: 10.1093/jacamr/dlaa051 5 Frost I, Van Boeckel TP, Pires J et al. Global geographic trends in antimicrobial resistance: the role of international travel. J Travel Med 2019; 26: taz036; zitiert in [1] AMR rate will increase: • Many COVID-19 patients especially those requiring ventilation or prolonged stays in intensive care units, are additionally treated with antibiotics out of concern for assumed secondary, bacterial coinfections, even though the actual rate of these coinfections is relatively low. One review cited in "JAC-Antimicrobial Resistance" reported that merely 8 percent of the patients mentioned in publications were experiencing bacterial/fungal coinfections. However, nearly three quarters of all patients (72%) received treatment with antibiotics [2]. • Speculation concerning the potential efficacy of hydroxychloroquine in combination with the antibiotic azithromycin has led to increased use of antibiotics. However, the assumed efficacy in cases of COVID-19 has not been proven. → Although the absolute number of patients treated in hospitals has decreased during the pandemic, that patients are more likely to be treated with broad-spectrum antibiotics during the pandemic [3]. AMR rate will not increase: • The AMR rate is affected by many factors. The global spread/distribution of drug-resistant pathogens is of greater importance for an increase in the AMR rate than antibiotics prescriptions [4]. • The COVID-19 pandemic has led to unprecedented changes in social interactions: social distancing or, more precisely, physical distancing, voluntary self-isolation and refraining from travel reduce the spread of drug-resistant pathogens. International travel has been repeatedly cited as a significant risk factor for exposure to drug-resistant pathogens [5]. • Additionally, physical distancing has also resulted in a drop in the rates of other infectious diseases (e.g. flu). → Globally, changes in AMR rates will not be uniform. In wealthier and developed countries, resistance rates will likely decrease. In countries with less advanced healthcare systems, poor hygiene and inadequate potable water supplies, there is a high risk of favourable conditions for the spread of antimicrobial-resistant bacteria [4]. The COVID-19 pandemic is having an enormous impact on public health. Because many COVID-19 patients are also treated with antibiotics, there is growing concern that antimicrobial resistances (AMR) could increase. In this regard, the trade journal "JAC-Antimicrobial Resistance" requested experts to provide an opinion in a PRO/CON debate on the question of the potential impact of COVID-19 on AMR rates [1]. COVID-19 pandemic and antibiotic resistances Is there a connection? Conclusion: The impact of the global COVID-19 pandemic on the emergence of antibiotic resistances must continue to be monitored. AMR rates are likely to be heterogeneous due to variations in health-care practices, such as the specific antimicrobials used, infection prevention and control interventions, among different countries during the pandemic [1]. PRO CON