Thinking about AMR again?

by Gwen Knight

Before the coronavirus 2019 (COVID-19) pandemic began, many of us were spending most of our working lives addressing the other huge global public health challenge that is AMR. As I have had to pick up on some neglected AMR projects with looming deadlines, I’ve recently spent some time thinking again about this problem and what the future holds for AMR.

To do this, I’ve been reading the opinion pieces coming out from several organisations (such as ReAct and JPIAMR) which are outline the possible ways that the two issues are linked. I’ve also tried to keep up with the growing published literature outlining what may happen to AMR in the face of COVID-19. Clancy et al. in Clinical Infectious Diseases give a great summary (from a US perspective) on the wider impact of COVID-19 on nosocomial superinfections, AMR and what we can expect. From a more UK angle, researchers at Imperial College London in JAC consider the potential long-term impact on AMR and balance overuse with increased hygiene and telemedicine, which in some settings will reduce the overall need for antibiotics. Dr Murray in Frontier in Microbiology splits the link into considerations in the clinic, the wider environment and in relation to public awareness, urging us all to wash our hands!

The relationship between COVID-19 and AMR is complex. Without data, we are still only postulating on what the impact of each on the other is and will be. For example, does background AMR prevalence impact COVID-19 mortality rates? The early signals suggest not, as a recent systematic review found evidence for only 7% (95% CI 3-12%) of COVID-19 patients having a bacterial co-infection (Lansbury et al, 2020). However, the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) has now reported that 84% of COVID-19 patients and 91% of those admitted to ICUs received antibiotics in their cohort. What will the impact of this be on selection and transmission of AMR against huge contemporary reductions in elective procedures in many hospitals in the UK for example? Substantial changes had already been seen in prescribing in English General Practices by March 2020: prescriptions for some antibiotics such as doxycycline and amoxicillin increased, whilst prescription for others such as flucloxacillin (commonly used to treat skin infections), nitrofurantoin and trimethoprim (commonly used to treat urinary tract infections) have decreased.

My current take is that it is complex and not as easy as saying that AMR is likely to be worse once we emerge from this COVID-19 dominated time. You can have a look for yourself at the resources that we thought worth highlighting on our new COVID-19 and AMR page on our Centre website. Here you’ll find two big online databases of resources on this topic from researchers at Liverpool and BSAC/JAC, as well as links to the main literature pieces mentioned above. As a Centre we are now trying to pull together the many strands of overlap between two of the greatest public health challenges of our generation – watch this space.

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