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18.11.2020

COVID-19 & antibiotic resistance: parallels, connections and consequences

NRP 72 researchers as well as other specialists give an overview of the parallels and connections between COVID-19 and antibiotic resistance.

COVID-19 is impacting NRP 72. For several months now, many researchers whose primary field of expertise is antibiotic resistance have had to put their work for the programme on hold because their professional services have been required to deal with the coronavirus pandemic. As infectiologists and heads of hospital laboratories or hygiene departments, they are making a significant contribution to combating the crisis.

However, the overlap between COVID-19 and antibiotic resistance goes further than just the people working on them. There are certain key areas where the two can be seen as parallel, and even connected, pandemics. There are obviously significant differences too. For example, COVID-19 is a single virus strain that has travelled round the world at breakneck speed, whereas antibiotic resistance occurs in an extremely wide variety of bacterial pathogens and spreads more slowly, but is nevertheless difficult to contain in the long term.

Despite these differences, key measures to combat COVID-19 and antibiotic resistance share common ground, for example in terms of the habits people adopt to protect themselves and particularly in terms of epidemiological oversight. While antibiotic resistance is less of an acute issue at present, the coronavirus pandemic illustrates clearly the effect it could have in the future. To avoid a preventable large-scale emergency in the future, it is important to learn the lessons of the current crisis and to establish whether COVID-19 is likely to impact the issue of antibiotic resistance – and, if so, how. Conversely, experience from combating antibiotic resistance could be useful in efforts to deal with COVID-19.

With these goals in mind, researchers and specialists working on NRP 72 have been describing and discussing the parallels and connections between COVID-19 and antibiotic resistance in a special issue of Swiss Medical Forum and in Swiss Medical Weekly. It is to be hoped that the analysis of the corona pandemic will also draw attention to the pandemic potential of antibiotic resistance, as Stefan Kuster, Head of the Communicable Diseases Division of the FOPH, writes in the editorial of the Swiss Medical Forum.

The news articles published today deal with the following topics:

Similar transmission routes, different speeds

Silent carriers, poor hygiene and international mobility are three of the key contributors to the global spread of COVID-19 and antibiotic resistance. While resistance spreads more slowly, it is also harder to combat. One of the main reasons for this is that ‘good’ bacteria – particularly gut bacteria – that do not cause disease but are part of our normal gut flora are becoming resistant too. The article discusses the measures that could contain both COVID-19 and antibiotic resistance, and what else is needed to control antibiotic resistance in the long term.

Crisis highlighting the need for antibiotic stewardship

The symptoms of COVID-19 are typically so unspecific that they could just as well be a bacterial infection. In many cases, therefore, antibiotics may have been incorrectly prescribed – particularly in the early stages of the pandemic – owing to the lack of a clear diagnosis. This underscores the urgent need for antibiotic stewardship. The article outlines the basic features of a nationwide antibiotic stewardship system of the type being developed by Swissnoso, the National Center for Infection Control, as part of the Strategy on Antibiotic Resistance (StAR).

Hygiene, masks and bumping elbows: possible effects on the spread of antibiotic resistance

In recent months, people around the world have adopted precautionary habits to protect themselves against infection. If a few of these habits became permanent, they would help slow the spread of antibiotic resistance. The article analyses the associated potential and also points out the possible negative impact of the COVID-19 pandemic on vaccine uptake, for example.

Could treatment decisions based on point-of-care testing benefit COVID-19 patients too?

As far as is known, COVID-19 patients rarely have a bacterial lung infection in addition to their coronavirus infection. In cases where they do, however, treatment with antibiotics is important. Unfortunately, the difficulty of making a clear diagnosis frequently results in antibiotics being prescribed unnecessarily. The article discusses the benefits of various diagnostic techniques in recognising concomitant bacterial infections in COVID-19 patients, particularly in the general practice setting.

Monitoring infection: analogies between COVID-19 and antibiotic resistance

A constantly evolving epidemiological situation and complex chains of transmission not only make COVID-19 contact tracing a huge challenge, they also make it difficult to monitor antibiotic resistance. However, monitoring is essential for quickly identifying and intervening in outbreaks. The article discusses the importance of antibiotic resistance monitoring of the type performed in Switzerland by ANRESIS, looks at new methods being developed as part of the Swiss Pathogen Surveillance Platform, and explores them in the context of current experience during the COVID-19 pandemic.

Treating COVID-19 patients with concomitant bacterial infections

Patients with viral infections often have simultaneous bacterial infections. These may be partly responsible for the symptoms they display at the outset or they may occur later as a consequence of the viral infection. In the context of COVID-19, the focus is on additional infections of the respiratory tract. While uncommon, they can nevertheless require specific treatment. The article summarises what we know as at September 2020 on the incidence, diagnosis and treatment of such infections and provides pointers for antibiotic treatment.

COVID-19 pandemic lays bare precarious antibiotics supply situation

The COVID-19 pandemic shows just how heavily dependent supplies of medicines and medical devices are on global supply chains. Various countries are experiencing supply bottlenecks, notably for antibiotics. This hardly came as a surprise: the problem had long been known in the case of antibiotics. But the measures taken so far appear to be guided more by short-term reaction than by long-term planning. The article provides an overview and describes various approaches to resolving the issue.

Using the crisis to make healthcare systems more resilient

Both COVID-19 and antibiotic resistance are challenges that are revealing weaknesses in healthcare systems worldwide. The COVID-19 pandemic has now unleashed huge political momentum. The article argues that this should be leveraged to improve healthcare systems’ overall resilience to outbreaks of infectious diseases. To this end it sets out a common framework for addressing both antibiotic resistance and COVID-19.

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Stéphane Praz Head of Knowledge Transfer +41 76 582 90 20 stephane.praz@leporis.ch