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Coronavirus Disease 2019, Superinfections, and Antimicrobial Development: What Can We Expect?
Cornelius J Clancy1, M Hong Nguyen1
1Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Abstract:
Coronavirus disease 2019 (COVID-19) arose at a time of great concern about antimicrobial resistance (AMR). No studies have specifically assessed COVID-19-associated superinfections or AMR. Based on limited data from case series, it is reasonable to anticipate that an appreciable minority of patients with severe COVID-19 will develop superinfections, most commonly pneumonia due to nosocomial bacteria and Aspergillus. Microbiology and AMR patterns are likely to reflect institutional ecology. Broad-spectrum antimicrobial use is likely to be widespread among hospitalized patients, both as directed and empiric therapy. Stewardship will have a crucial role in limiting unnecessary antimicrobial use and AMR. Congressional COVID-19 relief bills are considering antimicrobial reimbursement reforms and antimicrobial subscription models, but it is unclear if these will be included in final legislation. Prospective studies on COVID-19 superinfections are needed, data from which can inform rational antimicrobial treatment and stewardship strategies, and models for market reform and sustainable drug development.
Insights
Severe COVID-19 patients may face superinfections, increasing antimicrobial resistance (AMR) concerns. New studies are needed to guide rational treatment and combat AMR during the pandemic.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- The COVID-19 pandemic emerged amidst growing concerns regarding antimicrobial resistance (AMR).
- Limited data exists on superinfections and AMR patterns specifically associated with COVID-19.
- Nosocomial infections and broad-spectrum antimicrobial use are anticipated in severe COVID-19 cases.
Purpose of the Study:
- To assess the potential for COVID-19-associated superinfections.
- To understand the implications for antimicrobial resistance (AMR).
- To highlight the need for stewardship and further research.
Main Methods:
- Review of limited case series data.
- Anticipation of common superinfecting pathogens (e.g., nosocomial bacteria, Aspergillus).
- Analysis of likely antimicrobial prescribing patterns.
Main Results:
- A significant minority of severe COVID-19 patients are expected to develop superinfections, primarily pneumonia.
- Microbiology and AMR patterns will likely mirror local hospital environments.
- Widespread use of broad-spectrum antimicrobials is probable.
Conclusions:
- Antimicrobial stewardship is critical to mitigate unnecessary use and curb AMR.
- Prospective studies are essential to inform treatment and stewardship strategies.
- Policy reforms for antimicrobial reimbursement and drug development are under consideration.
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