Could COVID-19 lead to an increase in antimicrobial resistance?

Could COVID-19 lead to an increase in antimicrobial resistance?
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According to a new study, the use of antibiotics in the treatment of COVID-19 could lead to an increase in antimicrobial resistance (AMR) among the wider population.

Current treatment of COVID-19 involves giving antibiotics to patients to prevent secondary infections, however, researchers at the University of Plymouth and Royal Cornwall Hospital Trust suggests the increased use of antibiotics during the pandemic could be placing an additional burden on wastewater treatment works, potentially leading to an increase in antimicrobial resistance.

The team note that this could lead to raised levels of antibiotics in the UK’s rivers and coastal waters, which may in turn result in an increase in AMR, particularly in receiving water from wastewater treatment works that serve large hospitals, or emergency ‘Nightingale’ hospitals, where there is a concentration of COVID-19 patients.

The report has been published in the Journal of Antimicrobial Chemotherapy.

Using antibiotics as part of COVID-19 treatment

According to recent reports, up to 95% of COVID-19 inpatients are being prescribed antibiotics as part of their treatment. This is raising concerns that such a large-scale drug administration could have wider environmental implications.

Sean Comber, Professor of Environmental Chemistry in Plymouth and the article’s lead author, said: “COVID-19 has had an impact on almost every aspect of our lives. But this study shows its legacy could be felt long after the current pandemic has been brought under control.

“From our previous research, we know that significant quantities of commonly prescribed drugs do pass through treatment works and into our water courses. By developing a greater understanding of their effects, we can potentially inform future decisions on prescribing during pandemics, but also on the location of emergency hospitals and wider drug and waste management.”

Neil Powell, Consultant Pharmacist at the Royal Cornwall Hospital said: “Common with other hospitalised patients in the UK, and other countries, the majority of our patients with COVID symptoms were prescribed antibiotics because it is very difficult to know whether a patient presenting with symptoms of COVID has an overlying bacterial infection or not. We did a lot of work to try and identify those patients who were unlikely to have a bacterial infection complicating their viral COVID infections in an attempt to reduce the amount of antibiotic exposure to our patients and consequently the environment.”

Antibiotics seeping into wastewater

For the research, the team used available environmental impact data and modelling tools developed by the UK water industry and focussed on one UK emergency hospital in Harrogate. The research showed that the risks posed by doxycycline was low, assuming the hospital was at full capacity.

Tom Hutchinson, Professor of Environment and Health at the University and a co-author on the research, added: “This is a comprehensive environmental safety assessment which addresses potential risks to fish populations and the food webs they depend on. The data for amoxicillin indicated that while there was little threat of direct impacts on fish populations and other wildlife, there is a potential environmental concern for selection of AMR if at 100% capacity.”

Mathew Upton, Professor of Medical Microbiology at the university and a co-author on the research, added: “Antibiotics underpin all of modern medicine, but AMR is an issue that could impact millions of lives in the decades to come. Currently, the COVID-19 pandemic is causing immense suffering and loss of life across the globe, but AMR has been – and will remain – one of the most significant threats to global human health.

“We conducted this study so that we can begin to understand the wider impact of global pandemics on human health. It is clear that mass prescribing of antibiotics will lead to increased levels in the environment and we know this can select for resistant bacteria. Studies like this are essential so that we can plan how to guide antibiotic prescription in future pandemics.”

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