LETTERS TO THE EDITOR
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2020 - Universidad Ricardo PalmaDOI 10.25176/RFMH.v20i4.3050
ANTIBIOTIC CONTROL IN TIMES OF COVID-19
CONTROL DE ANTIBIÓTICOS EN TIEMPOS DE COVID-19
Christian Chiara-Chilet1,a, Marcos Saavedra-Velasco2,a
1Instituto Nacional de Salud del Niño San Borja. Lima-Perú.
2Universidad Norbert Wiener, Lima-Perú.
aMedical specialist in Infectious and Tropical Diseases
Mr. Editor:
During the COVID-19 pandemic, an increase in the use of antibiotics is probably one of the main reasons for the uncertainty regarding the therapeutic arsenal against SARS-CoV-2 and the discontinuity of antibiotic control programs(1).
According to the World Health Organization (WHO), infections by resistant germs cause at least 700,000 deaths a year worldwide. If the necessary measures are not taken in the future, deaths could increase to 10 million by the year. 2050(3).
In this context, there is evidence that antibiotics do not fight COVID-19, unless the patient has a proven bacterial co-infection. In a review study on bacterial or fungal coinfections in patients with COVID-19, it was found that 62/806 (8%) of patients presented some type of coinfection during hospital admission. A secondary analysis showed that 1450/2010 ( 72%) of patients received antibiotic therapy(3).
Another identified drawback is that the traditional markers used for the initiation and follow-up of antibiotic treatment, such as the number of leukocytes, C-reactive protein, or imaging studies, are also usually altered in SARS-CoV-2 infection (4,5). For this reason, the use of procalcitonin is recommended(6,7), since, normally, viruses release interferon, which inhibits the release of procalcitonin(8). However, a meta-analysis concluded that elevated procalcitonin levels were associated up to almost five times with an increased risk of severe COVID-19 (OR, 4.76; 95% CI, 2.74–8.29) (9). Probably due to coinfections bacterial or, perhaps, by the intrinsic severity of COVID-19. However, in the early stages, procalcitonin has proven useful in detecting possible coinfections in adults and children with COVID-19(5,10)
What can we do to stop antibiotic resistance in times of pandemic? From the point of view of the Community view, it is necessary to promote handwashing and non-self-medication. In addition to secondary prevention, vaccination against pathogens causes respiratory infections, such as pneumococcus or influenza virus(2,11).
It is necessary to correctly use diagnostic tests and document possible bacterial co-infections at the hospital level, being necessary to perform the corresponding microbiological tests before starting the empirical antibiotic. In addition, the role of the intra-hospital infection committees must be recognized and strengthened, which constitutes an essential pillar in the management of antimicrobials(12).
In conclusion, resistance to antibiotics could increase during the COVID-19 pandemic. We must consider that the prevalence of bacterial coinfections in COVID-19 appears to be low. The use of antibiotics should be controlled in turn by the infection committee of each hospital. We must also consider the importance of implementing educational and preventive measures in the community.
During the COVID-19 pandemic, an increase in the use of antibiotics is probably one of the main reasons for the uncertainty regarding the therapeutic arsenal against SARS-CoV-2 and the discontinuity of antibiotic control programs(1).
According to the World Health Organization (WHO), infections by resistant germs cause at least 700,000 deaths a year worldwide. If the necessary measures are not taken in the future, deaths could increase to 10 million by the year. 2050(3).
In this context, there is evidence that antibiotics do not fight COVID-19, unless the patient has a proven bacterial co-infection. In a review study on bacterial or fungal coinfections in patients with COVID-19, it was found that 62/806 (8%) of patients presented some type of coinfection during hospital admission. A secondary analysis showed that 1450/2010 ( 72%) of patients received antibiotic therapy(3).
Another identified drawback is that the traditional markers used for the initiation and follow-up of antibiotic treatment, such as the number of leukocytes, C-reactive protein, or imaging studies, are also usually altered in SARS-CoV-2 infection (4,5). For this reason, the use of procalcitonin is recommended(6,7), since, normally, viruses release interferon, which inhibits the release of procalcitonin(8). However, a meta-analysis concluded that elevated procalcitonin levels were associated up to almost five times with an increased risk of severe COVID-19 (OR, 4.76; 95% CI, 2.74–8.29) (9). Probably due to coinfections bacterial or, perhaps, by the intrinsic severity of COVID-19. However, in the early stages, procalcitonin has proven useful in detecting possible coinfections in adults and children with COVID-19(5,10)
What can we do to stop antibiotic resistance in times of pandemic? From the point of view of the Community view, it is necessary to promote handwashing and non-self-medication. In addition to secondary prevention, vaccination against pathogens causes respiratory infections, such as pneumococcus or influenza virus(2,11).
It is necessary to correctly use diagnostic tests and document possible bacterial co-infections at the hospital level, being necessary to perform the corresponding microbiological tests before starting the empirical antibiotic. In addition, the role of the intra-hospital infection committees must be recognized and strengthened, which constitutes an essential pillar in the management of antimicrobials(12).
In conclusion, resistance to antibiotics could increase during the COVID-19 pandemic. We must consider that the prevalence of bacterial coinfections in COVID-19 appears to be low. The use of antibiotics should be controlled in turn by the infection committee of each hospital. We must also consider the importance of implementing educational and preventive measures in the community.
Author’s contributions: The authors participated in the genesis of the idea, information analysis, and preparation of the manuscript of this research work.
Funding: Self-financed.
Conflicts of interest: None of the authors has conflicts of interest.
Recibido: 24 de agosto 2020
Aprobado: 25 de agosto 2020
Correspondence: Christian Manuel Chiara Chilet
Address: López de la Romaña 170 interior A, La victoria, Lima-Perú.
Telephone: 913016785
Email: christianch2@hotmail.com
BIBLIOGRAPHIC REFERENCES
1. Hsu J. How covid-19 is accelerating the threat of antimicrobial resistance. BMJ. 2020;369:m1983. DOI: https://doi.org/10.1136/bmj.m1983
2. WHO. No podemos esperar: Asegurar el futuro contra las infecciones farmacorresistentes Abril 2019. Disponible en: https://www.who.int/antimicrobial-resistance/interagency-coordination-group/final-report/es/
3. Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020:ciaa530. DOI: https://doi.org/10.1093/cid/ciaa530
4. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. New England Journal of Medicine. 2020;382(8):727-33. DOI: 10.1056/NEJMoa2001017
5. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054-62. DOI: https://doi.org/10.1016/S0140-6736(20)30566-3
6. Meier MA, Branche A, Neeser OL, Wirz Y, Haubitz S, Bouadma L, et al. Procalcitonin-guided Antibiotic Treatment in Patients With Positive Blood Cultures: A Patient-level Meta-analysis of Randomized Trials. Clin Infect Dis. 2019;69(3):388-96. DOI: https://doi.org/10.1093/cid/ciy917
7. Self WH, Balk RA, Grijalva CG, Williams DJ, Zhu Y, Anderson EJ, et al. Procalcitonin as a Marker of Etiology in Adults Hospitalized With Community-Acquired Pneumonia. Clin Infect Dis. 2017;65(2):183-90. DOI: https://doi.org/10.1093/cid/cix317
8. Gilbert DN. Procalcitonin as a biomarker in respiratory tract infection. Clin Infect Dis. 2011;52 Suppl 4:S346-50. DOI: https://doi.org/10.1093/cid/cir050
9. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta. 2020;505:190-1. DOI: https://dx.doi.org/10.1016%2Fj.cca.2020.03.004
10. Peng D, Zhang J, Xu Y, Liu Z, Wu P. The role of procalcitonin in early differential diagnosis of suspected children with COVID-19. medRxiv. 2020:2020.04.07.20057315. DOI: https://doi.org/10.1101/2020.04.07.20057315
11. Lundgren F, Maranhão B, Martins R, Chatkin JM, Fouad Rabahi MF M, Amorim Corrêa R, et al. Vaccination in the prevention of infectious respiratory diseases in adults. Revista da Associação Médica Brasileira. 2014;60:4-15. DOI: https://doi.org/10.1590/1806-9282.60.02.004
12. Ostrowsky B, Banerjee R, Bonomo RA, Cosgrove SE, Davidson L, Doron S, et al. Infectious Diseases Physicians: Leading the Way in Antimicrobial Stewardship. Clin Infect Dis. 2018;66(7):995-1003. DOI: https://doi.org/10.1093/cid/cix1093
