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How covid-19 is accelerating the threat of antimicrobial resistance

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1983 (Published 18 May 2020) Cite this as: BMJ 2020;369:m1983

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Re: How covid-19 is accelerating the threat of antimicrobial resistance

Dear Editor,

The problem highlighted in the article is genuinely alarming. It has added its bit to the prevailing large scale and indiscriminate use of antibiotics, not only for treatment of other human and animal diseases, but also in animal food production systems. The tools for emergence and spread of antibiotic resistance and ‘resistome’ analysis are available and are making some predictions as well [1, 2].

To add to the problem of AMR emergence, large scale use of disinfectants and sanitizers in the wake of Covid-19 pandemic is affecting the microbiomes of various ecological niches in humans, animals and environments. ‘Dysbiosis’ in host-commensal interrelationships is the likely outcome of such practices, thereby impacting immune functioning, metabolism, physiological parameters and host’s susceptibility to various infectious and non-infectious diseases [3]. Alcohol resistance (resistance to 70% ethanol or isopropanol in hand disinfectants or sanitizers in healthcare premises) in Enterococcus faecium, a nosocomial pathogen and its vancomycin resistant strains (as superbugs) has recently been reported [4]. The dilemma is that in fighting against one i.e., Covid-19 pandemic, we face collateral damage by losing several commensals and possibly creating space for newer threats. I think, we should be prepared for the future with tools that allow forecast or predictions about the newer threats.

Prebiotics, probiotics, immunobiotics, synbiotics, etc. are promising correctives for dysbiosis, with some evidence existing [5]. But I see the scale of the current problem of excessive use of disinfectants much larger than for mere personal hygiene and sanitation in such events as 'panic use of sprays of sodium hypochlorite on people and premises alike', clinics and hospital premises, entire campuses, hotels, trains, buses, aeroplanes, houses or to name anything! And it has been continuing and is likely to continue for several weeks around the world.

Therefore, I believe that it is not only a concern of emergence of resistance or tolerance to antimicrobials, disinfectants and sanitizers, but also of ‘wiping’ of several microbiota in various ecological niches with the impact unpredictable so far. Our tools and the times to come would hopefully reveal that loss. Till then, we should be guided by the prevailing wisdom of (excessive) use of sanitizers, disinfectants for hands and places, for both practical and psychological cleansing, and indiscriminate use of antibiotics for the secondary infections in Covid-19 patients, waiting for a vaccine and/or specific antiviral agent(s).

References
1. Mahnert A, et al. Man-made microbial resistances in built environments. Nat Commun 10 (2019), 968.
2. Crofts TS, Gasparrini AJ and Dantas G. Next-generation approaches to understand and combat the antibiotic resistome. Nature Rev Microbiol 15 (2017), 422-434.
3. Lynch JB and Hsiao Y. Microbiomes as sources of emergent host phenotypes. Science 365(2019), 1405-1409.
4. Pidot SJ, et al. Increasing tolerance of hospital Enterococcus faecium to handwash alcohols. Sci. Transl. Med. 10(2018), eaar6115.
5. Zelaya H, et al. Respiratory antiviral immunity and immunobiotics: Beneficial effects on inflammation-coagulation interaction during Influenza virus infection. Front Immunol 7 (2016), 633.

Competing interests: No competing interests

20 May 2020
Ajit Singh
Emeritus Scientist (ICAR) & Former Professor
Department of Veterinary Microbiology, Lajpat Rai University of Veterinary and Animal Sciences, Hisar-125004, India