COVID-19 drug practices risk antimicrobial resistance evolution.
COVID-19 drug practices risk antimicrobial resistance evolution.
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DOI：
10.1016/s2666-5247(21)00039-2
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发表时间：
2021-04
期刊：
影响因子：
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通讯作者：
MetaSUB Consortium
中科院分区：
文献类型：
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作者：
Afshinnekoo E;Bhattacharya C;Burguete-García A;Castro-Nallar E;Deng Y;Desnues C;Dias-Neto E;Elhaik E;Iraola G;Jang S;Łabaj PP;Mason CE;Nagarajan N;Poulsen M;Prithiviraj B;Siam R;Shi T;Suzuki H;Werner J;Zambrano MM;Bhattacharyya M;MetaSUB Consortium
抗微生物药物耐药性是现代医学面临的最大挑战之一。由于COVID-19的管理越来越依赖于药物干预，因此加速抗微生物药物耐药性演变和传播的风险更大。一项在三级医院环境中的研究揭示了微生物在长时间内的定植模式。它还强调了医院中抗菌素耐药性基因库的多样性，这可能促进抗生素耐药性新模式的出现和传播。由于2019冠状病毒病（COVID-19）大流行，过去一年三级医院的入院和出院人数大幅增加，许多医院的规模超出了负荷。由于COVID-19导致住院人数超过正常能力，再加上患者免疫功能受损，合并感染的风险大大增加。2,3由于对COVID-19引起的合并感染和合并症缺乏全面了解，导致世界各地的患者处理方案迅速变化，包括使用多种药物（图）。在长期大流行期间，为预防COVID-19患者继发感染而使用抗寄生虫、抗病毒、抗菌和抗炎药物，不可避免地会导致未来的并发症，包括抗生素耐药性的加剧。考虑到增加SARS-CoV-2适应度的突变的连续出现，这一点尤其重要，这可能是导致复发性COVID-19波的原因。值得注意的是，由于这些药物大多数用于其他目标病原体，我们不仅可能会增加COVID-19的耐药性，而且还会在治疗其他细菌和病毒感染方面面临挑战。由于药物经常被新的治疗选择所取代（图），对抗菌素耐药性增加演变和传播的担忧已成为现实。尽管缺乏科学证据，但在治疗COVID-19过程中，对各种药物的需求和滥用不断增加。6 .一些论文在没有经过广泛同行评审的情况下迅速发表，并没有得到世卫组织和各国疾病控制和预防中心的建议，这甚至加剧了这种情况
Antimicrobial resistance is one of the biggest challenges facing modern medicine. Because the management of COVID-19 is increasingly becoming dependent on pharmacological interventions, there is greater risk for accelerating the evolution and spread of antimicrobial resistance. A study in a tertiary hospital environment revealed concerning colonisation patterns of microbes during extended periods. 1 It also highlighted the diversity of antimicrobial resistance gene reservoirs in hospitals that could facilitate the emergence and transmission of new modes of antibiotic resistance.Admission and release of patients from tertiary hospitals have risen dramatically in the past year due to the COVID-19 pandemic, with many hospitals expanding beyond capacity. With hospitalisations exceeding normal capacity due to COVID-19 combined with impaired immune function in patients, risks of co-infections have substantially increased. 2, 3 The gap in a comprehensive understanding of coinfection and comorbidity caused by COVID-19 has led to rapidly changing protocols for patient handling, including administering multiple drugs around the world (figure). 4 The use of antiparasite, antiviral, antibacterial, and anti-inflammatory drugs for preventing secondary infections in patients with COVID-19 during a prolonged pandemic will inevitably invite future complications, including aggravation of antimicrobial resistance. This is particularly relevant in light of the successive emergence of mutations that increase SARS-CoV-2 fitness, which could be responsible for recurrent COVID-19 waves. 5 Of note, because most of these drugs are used for other target pathogens, we might not only increase resistance in COVID-19 but also face challenges in the treatment of other bacterial and viral infections. With drugs frequently replaced by new therapeutic options (figure), the fear of increased antimicrobial resistance evolution and spread are a reality. There was an increasing demand for and misuse of various drugs in the treatment of COVID-19 irrespective of paucity of scientific evidence. 6 This has even been exacerbated by rapid publication of some papers without extensive peer-review and their recommendations by WHO and the centres for disease control and prevention across