Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Clin Infect Dis. 2020 Dec 17;71(10):2736-2743. doi: 10.1093/cid/ciaa524.
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.
2019 年冠状病毒病（COVID-19）的出现引起了人们对抗微生物药物耐药性（AMR）的极大关注。目前尚无专门评估 COVID-19 相关合并感染或 AMR 的研究。根据来自病例系列的有限数据，合理预期相当一部分重症 COVID-19 患者会发生合并感染，最常见的是医院获得性细菌和曲霉菌引起的肺炎。微生物学和 AMR 模式可能反映了机构生态。广谱抗菌药物的使用在住院患者中很可能很普遍，无论是有针对性的治疗还是经验性治疗。合理用药将在限制不必要的抗菌药物使用和 AMR 方面发挥关键作用。国会的 COVID-19 救助法案正在考虑抗菌药物报销改革和抗菌药物订阅模式，但最终立法是否会包括这些内容尚不清楚。需要对 COVID-19 合并感染进行前瞻性研究，从中获得的信息可以为合理的抗菌药物治疗和管理策略提供依据，并为市场改革和可持续药物开发提供模型。
