Clancy Cornelius J, Buehrle Deanna J, Nguyen M Hong
University of Pittsburgh, Department of Medicine, Pittsburgh, PA, USA.
VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
JAC Antimicrob Resist. 2020 Sep;2(3):dlaa049. doi: 10.1093/jacamr/dlaa049. Epub 2020 Jul 17.
We argue that the COVID-19 pandemic will result in increased antimicrobial resistance (AMR). Broad-spectrum antibiotic use is common among hospitalized COVID-19 patients and in excess of reported secondary infection rates, suggesting unnecessary prescribing. Selection pressure is likely to be particularly intense in COVID-19 epicentres and within non-epicentre hospital units dedicated to COVID-19 care. Risk factors that increase the likelihood of hospitalization or poor outcomes among COVID-19 patients, such as advanced age, nursing home residence, debilitation, diabetes and cardiopulmonary or other underlying systemic diseases, also predispose to AMR infections. Worry for AMR emergence is heightened since first-wave COVID-19 epicentres were also AMR epicentres. Disruptive direct and indirect effects of COVID-19 globally on economic systems, governance and public health expenditure and infrastructure may fuel AMR spread. We anticipate that the impact of COVID-19 on AMR will vary between epicentres and non-epicentres, by geographic region, hospital to hospital within regions and within specific hospital units.
我们认为，新冠疫情将导致抗菌药物耐药性（AMR）增加。广谱抗生素在住院的新冠患者中使用普遍，且超过了报告的继发感染率，这表明存在不必要的处方行为。在新冠疫情中心以及专门负责新冠治疗的非疫情中心医院科室中，选择压力可能尤为巨大。新冠患者中增加住院可能性或导致不良预后的风险因素，如高龄、居住在养老院、身体虚弱、糖尿病以及心肺或其他潜在的全身性疾病，也易引发抗菌药物耐药性感染。由于第一波新冠疫情中心也是抗菌药物耐药性的高发地区，因此对抗菌药物耐药性出现的担忧加剧。新冠疫情在全球范围内对经济系统、治理以及公共卫生支出和基础设施造成的直接和间接破坏影响，可能会助长抗菌药物耐药性的传播。我们预计，新冠疫情对抗菌药物耐药性的影响在疫情中心和非疫情中心之间、不同地理区域之间、区域内不同医院之间以及特定医院科室内部都会有所不同。
