The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus that was only recently discovered in 2019. The virus causes the COVID-19 pandemic which currently requires the full focus, commitment and support from all governments, international institutions and organizations, the healthcare workforce, the private sector, civil society and the general public.
Some attention has started to be given to the role of secondary infections as well as antibiotic resistance in patients with COVID-19. Currently, however, too little information is available to draw any full conclusions on the potential impact antibiotic resistance might have on COVID-19 outcomes.
Secondary infections in COVID-19 patients
A recently published Lancet study looked at 191 hospitalized adult patients in Wuhan, China, that had been diagnosed with COVID-19 and either had died or had been discharged at the end of January this year. Although the sample size was quite small, the researchers found that half of the patients who died (n=27/54) also had a secondary infection, and that all but one of them had been treated with antibiotics. This has been picked up by media around the world and has initiated a relevant discussion about the potential impact of antibiotic resistance on the outcomes of COVID-19 patients. At the center of thought is that countries with higher burden of antibiotic resistance might be worse off if secondary bacterial infections are a common complication.
However, it is worth noting that the secondary infections affecting the dying, hospitalized patients in Wuhan happened at a very late stage of the disease (median time was 17 days after the illness first began). The patients generally faced severe symptoms like sepsis and acute injuries to the heart and kidneys earlier (median time to onset in non-survivors was 10, 14.5 and 15 days, respectively). Sepsis – which often might have been caused by the SARS-CoV-2 virus itself – occurred in 100% of the patients who did not survive, whereas acute heart and kidney injuries happened to 59% and 50% of them, respectively.
So far it remains unclear whether the antibiotics did not work due to resistance, or whether the patients were so weak when they contracted the secondary infections, that death was inevitable. More and larger studies from different countries will be needed to shed more light on these issues. It will be important for the world’s response both in the more immediate term – and for long-term preventive actions – to understand what role secondary bacterial infections and antibiotic resistance might play in the current pandemic.
PHAGElogist 