SUMMARY

The anti-microbial resistance develops because the microbes which are resistant to
antimicrobial agents endure and replicates further which is contributed by abuse and in
appropriate utilization of antibiotics in humans animals and enviourment [1]

factors such as misuse and overuse of antibiotics attributes to the resistance crisis all over the
world as well as on the other hand the pharmaceutical industries also lack the development of
new drug due to less economic support and challenging regulatory requirements

The several studies have demonstrated that how antibiotic consumption is directly related
with the emergence of resistant bacteria in modern era and all this is contributed by lack of
regulation and easy accessibility of antibiotics in many countries all over the world
promoting unhealthy antibiotic consumption which subsequently results in to development of
resistance.

The major factors include

Incorrect prescribing and self-medication which can result into potential complication in the
patient consuming antibiotics as the inhibitory and therapeutic concentrations or these
antibiotics can promote the development of resistant strains by genetic alteration, mutation of
gene expression

On the other hand, the excessive use of growth supplements in livestock in order to promote
and prevention of infections by killing bacteria which indirectly can result into development
of resistant bacteria and when further those animals are consumed by human results into the
transfer of those resistant strains in to humans which ends up into serious infections.

in accordance to CDC in 2013, the mankind is currently in “POST-ANTIBIOTIC ERA”

whereas in 2014 WHO cautioned that antibiotic resistant crisis is turning out to be dreadful
and MDR is becoming major threat to united states public health

among gram positive the biggest threat of global pandemic by S. aureus and Enterococcus
species as rate of deaths each year in America due to MRSA is way greater as compared to
the other diseases such as HIV/AIDS, Parkinson’s disease, emphysema and homicide
combined. whereas on the other hand the vancomycin resistant enterococci and other
developing pathogens or becoming resistant to many common antibiotics and drug resistant
respiratory pathogens including streptococcus pneumoniae and mycobacterium tuberculosis
is epidemic globally

the Gram-negative microbes are especially troubling in light of the fact that they are getting
resistant to essentially all the anti-microbial medication choices accessible, making
circumstances reminiscent of pre-antibiotic era. [2] [4]

There are Several studies have shown that how antimicrobial resistance leads to the apparent
virulence of intestinal pathogens [3]

Another major drawback is that due to antimicrobial resistance the major complications has
to be faced while the selection of initial choice of agent for empirical treatment which can
lead to inappropriate choice of antimicrobial agent for initial therapy which further drives to
poor response These issues are becoming more important as the prevalence of resistance to
commonly used agents increases. [3]

AMR emergence in relation to COVID 19

Since the start of 2020 the processing COVAID-19 pandemic resulted into the deaths of
more than 250,000 patient in European union- European economic area. whereas
antimicrobial resistance bacterium infection result into death of more than 30,000
European. Other than that, of COVAID 19 AMR is another continues pandemic that
frequently goes unnoticed by majority of population So the question is that weather AMR
circumstance will intensify or improve as an outcome of current COVAID 19 pandemics. [13]

COVID 19 is viral infection so cannot be treated with antibiotics but this viral infection can result into
secondary bacterial infections such as pneumonia which is to be treated by anti-bacterial drugs. [6]

As COVID 19 patients may develop secondary bacterial coinfections which in according to

studies is related to critically ill, hospitalized patients, as risk factors for nosocomial
infections such as advanced age, underlying systemic diseases, mechanical ventilation,
prolonged hospital, ICU stays and prolong dependance on invasive mechanical ventilation of
patients with severe infection. [6][7]

In accordance to an analysis of published literature, Rawson et al.8 report that while only 8%

of patients included in publications had reported bacterial or fungal coinfection, 72% of
patients were treated with antibiotics. In the times of COVID 19 frequent use of antibiotics
empirically in relation to prolong intensive care and other factors can subsequently result into
increased AMR. [5] Studies based on Wuhan data show that the number of patients treated
with antibiotics ranges from 71% – 95% and issues of highly resistant bacteria have
complicated treatment (Zhou et al. 2020; Chen et al. 2020). [6]

The most common superinfections includes ventilator associated bacterial and fungal pneumonia
making the patient more susceptible to blood stream and urinary tract infections.[7] Organisms
cultured from patients included pandrug-resistant Acinetobacter baumannii, Klebsiella
pneumoniae carbapenemase–producing K. pneumoniae, extended-spectrum β-lactamase (ESBL)–
producing K. pneumoniae, ESBL-producing Pseudomonas aeruginosa, Enterobacter
cloacae, Serratia marcescens, Aspergillus fumigatus, Aspergillus flavus, Candida albicans,
and Candida glabrata [7][8][9][10]

According to the data of 2 hospitals the Median times to ICU admission and onset of secondary
infection was 10–12 days and 17 days after the first COVID-19 symptoms, respectively [ 11, 12].
Median time to death was 19 days, suggesting that superinfections were often terminal events.
And bboth as empiric and pathogen-directed therapy in critically ill patient is done by Broad-
spectrum antimicrobial. [7]

The coinfection with antibiotic-resistant bacteria – superbugs – can lead to a higher mortality
of COVID-cases [6]

Overall, it is clear that inappropriate treatment of COVID-19 and secondary infections, and
the use of antibiotics as a preventive measure can be an enormous driver of AMR. [6]

As a former Centres for Disease Control and Prevention (CDC) director notes:

“The challenge of antibiotic resistance could become an enormous force of additional

sickness and death across our health system as the toll of coronavirus pneumonia
stretches critical care units beyond their capacity” (Gerberding 2020) [6]

On the other side the measures taken in order to prevent the spread of COVID 19 such as
social distancing, isolation and reduction in national and international travel can play an
important role in reduction of spread of AMR pathogens [5]
The experiences from COVID-19 should fuel a research plan focused on evading a future
AMR pandemic frequently described as a "gradually arising calamity" that could demonstrate
much more expensive than COVID-19 [14]

 In this window of opportunity which COVID-19 has given us, the problem of AMR may be
understood more easily. Not just through pointing at direct linkages where co-infection with
antibiotic resistant bacteria– superbugs – can prompt a higher mortality of COVID-cases. But
in addition, COVID-19 can serve as a useful societal analogy for AMR that may help to
educate the public on the socio, economic and cultural implications of this mostly unknown
and rather complicated threat. [6]

It is suggested that in order to address this issue there should be ban on irrational drug
combinations in order to avoid abuse of antibiotics and to ban colistin as a growth promoter
in animals as they promote development of resistant strains, improve hospital infection
control, and implement better antimicrobial stewardship. Funds should be mobilised, and
regulatory barriers to new antibiotic development should be relaxed so that pharmaceutical
companies can develop new drugs. [15]

lastly it is recommended ‘to monitor evolution and effects of interventions, through

establishment of accurate surveillance systems on antimicrobial resistance in the human and
veterinary sector’ [16]

These efforts have been episodic and uneven across countries, however. Sustained funding
for antimicrobial resistance and globally harmonised targets to monitor progress are still
urgently needed. [15]

1. Robby Nieuwlaat, Lawrence Mbuagbaw, Dominik Mertz, Lori L Burrows, Dawn M E

Bowdish, Lorenzo Moja, Gerard D Wright, Holger J Schünemann, Coronavirus
Disease 2019 and Antimicrobial Resistance: Parallel and Interacting Health
Emergencies, Clinical Infectious Diseases, ,
ciaa773, https://doi.org/10.1093/cid/ciaa773
2. Ventola, C. L. (2015). The antibiotic resistance crisis: part 1: causes and
threats. Pharmacy and therapeutics, 40(4), 277.
3. Travers, K., & Michael, B. (2002). Morbidity of infections caused by antimicrobial-
resistant bacteria. Clinical Infectious Diseases, 34(Supplement_3), S131-S134.
4. Cassini, A., Högberg, L. D., Plachouras, D., Quattrocchi, A., Hoxha, A., Simonsen, G.
S., ... & Ouakrim, D. A. (2019). Attributable deaths and disability-adjusted life-years
caused by infections with antibiotic-resistant bacteria in the EU and the European
Economic Area in 2015: a population-level modelling analysis. The Lancet infectious
diseases, 19(1), 56-66.
5. David van Duin, Gavin Barlow, Dilip Nathwani, The impact of the COVID-19
pandemic on antimicrobial resistance: a debate, JAC-Antimicrobial Resistance,
Volume 2, Issue 3, September 2020, dlaa053,

6. de Vries, D., Hofstraat, K., & Spaan, V. COVID-19 as analogy for antimicrobial
resistance.

7. Cornelius J Clancy, M Hong Nguyen, Coronavirus Disease 2019, Superinfections,

and Antimicrobial Development: What Can We Expect?, Clinical Infectious Diseases,
, ciaa524, https://doi.org/10.1093/cid/ciaa524
8. Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., ... & Yu, T. (2020).
Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus
pneumonia in Wuhan, China: a descriptive study. The Lancet, 395(10223), 507-513.
9. Yang, X., Yu, Y., Xu, J., Shu, H., Liu, H., Wu, Y., ... & Wang, Y. (2020). Clinical
course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in
Wuhan, China: a single-centered, retrospective, observational study. The Lancet
Respiratory Medicine.
10. Wang, Z., Yang, B., Li, Q., Wen, L., & Zhang, R. (2020). Clinical features of 69
cases with coronavirus disease 2019 in Wuhan, China. Clinical infectious diseases.
11. Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., ... & Cheng, Z. (2020).
Clinical features of patients infected with 2019 novel coronavirus in Wuhan,
China. The lancet, 395(10223), 497-506.
12. Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., ... & Guan, L. (2020). Clinical
course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan,
China: a retrospective cohort study. The lancet.

13. Monnet Dominique L , Harbarth Stephan . Will coronavirus disease (COVID-19)

have an impact on antimicrobial resistance?. Euro Surveill. 2020;25(45):pii=2001886.
https://doi.org/10.2807/1560-7917.ES.2020.25.45.2001886
14. Wilson, L.A., Rogers Van Katwyk, S., Fafard, P. et al. Lessons learned from
COVID-19 for the post-antibiotic future. Global Health 16, 94 (2020).

https://doi.org/10.1186/s12992-020-00623-x

15.   Laxminarayan, R., Van Boeckel, T., Frost, I., Kariuki, S., Khan, E. A.,
Limmathurotsakul, D., ... & Peacock, S. J. (2020). The Lancet Infectious Diseases
Commission on antimicrobial resistance: 6 years later. The Lancet Infectious
Diseases, 20(4), e51-e60.

16. Hesp, A., Veldman, K., van der Goot, J., Mevius, D., & van Schaik, G. (2019). Monitoring
antimicrobial resistance trends in commensal Escherichia coli from livestock, the
Netherlands, 1998 to 2016. Eurosurveillance, 24(25), 1800438.

17.