Antimicrobial Resistance as a Hidden Menace Lurking Behind the COVID-19 Outbreak: The Global Impacts of Too Much Hygiene on AMR

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus that was recently discovered in 2019. While the world is working hard to overcome and control the coronavirus disease 2019 (COVID-19) pandemic, it is also crucial to be prepared for the great impacts of this outbreak on the development of antimicrobial resistance (AMR). It is predicted that inappropriate and too much use of antibiotics, biocides, and disinfectants during this pandemic may raise disastrous effects on antibiotic stewardship programs and AMR control all around the world. Furthermore, the use of certain antibiotics alone or in combination with antiviral agents or other medications for the treatment of secondary bacterial infections among COVID-19 patients may be regarded as a major factor that negatively affects host immune response by disrupting mitochondrial function and activity. Herein, we suggest that the current management strategies to control AMR and prioritize antibiotic stewardship schemes should be extremely highlighted in relation to the COVID-19 outbreak. The rising concerns about excessive use of antimicrobials and biocides and taking too much hygiene also need to be addressed during this pandemic due to their impacts on AMR, public health, and the environment.

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

“…Antibiotic treatments are mostly applied as prophylaxis to prevent further bacterial coinfections among hospitalized patients, but, in several countries, the common and extensive use of antimicrobials in the treatment of hospitalized COVID-19 patients is considered to be a part of the routine treatment package. Furthermore, it is possible that the amounts and types of antimicrobials used are currently under-documented and, thus, underestimated [ 32 , 33 ]. Additionally, the hype around premature reports of possible treatments for COVID-19 may also spike the prescription of antibiotics.…”

“…It is presumed that high concentrations of such microbicidal agents could kill most bacterial species that provide beneficial services to the ecosystem and to other living organisms. Furthermore, if the concentrations of microbicidal agents are at the subminimum inhibitory concentration, this may augment the selective pressure and drive the emergence of antimicrobial resistance [ 33 ].…”

The use of antibiotics in COVID-19 management: a rapid review of national treatment guidelines in 10 African countries

“…COVID-19 continues to threaten health systems globally and African countries are not spared [ 1 , 2 ]. Prior to the COVID-19 outbreak, antimicrobial resistance (AMR) has been a “hidden” pandemic threatening healthcare delivery worldwide, claiming 700,000 deaths per year [ 3 ]. According to the World Health Organization (WHO), AMR occurs when pathogens such as viruses, bacteria, parasites, and fungi undergo changes and no longer respond to treatment making infections difficult to treat, thus increasing the risk of disease spread, poor outcomes, and mortality [ 4 ].…”

“…In 2019, the WHO also identified AMR as one of the major threats facing healthcare systems [ 5 ]. AMR is a growing global health issue to which the present COVID-19 outbreak may contribute [ 3 ]. This situation is further complicated with the pressure to repurpose drugs to treat COVID-19, deteriorating economic conditions, and the shifting of resources away from antimicrobial stewardship programs resulting to indiscriminate use of antibiotics in COVID-19 treatment [ 6 ].…”

Should the Increased Awareness of the One Health Approach Brought by the COVID-19 Pandemic Be Used to Further Tackle the Challenge of Antimicrobial Resistance?

“…Moreover, the use of sanitizers and other biocidal agents (e.g., quaternary ammonium compounds (QACs), hydrogen peroxide, sodium hypochlorite, peroxyacetic acid, chlorine dioxide) has dramatically increased during the COVID-19 pandemic [ 23 ], hand hygiene and surface disinfection being among the most important preventative measures used globally to reduce SARS-CoV-2 transmission. Antimicrobial soaps and disinfectant cleaners could contaminate the environment, mostly through wastewater, in high concentrations and could select for AMR microorganisms [ 23 , 24 , 25 ]. Indeed, cross-resistance to clinically used antimicrobials has occurred following bacterial exposure and adaptation to some biocides [ 26 ].…”