The silent pandemic: Emergent antibiotic resistances following the global response to SARS-CoV-2

Abstract

The ongoing SARS-CoV-2 pandemic has highlighted the importance of the rapid development of vaccines and antivirals. However, the potential for the emergence of antibiotic resistances due to the increased use of antibacterial cleaning products and therapeutics presents an additional, underreported threat. Most antibacterial cleaners contain simple quaternary ammonium compounds (QACs); however, these compounds are steadily becoming less effective as antibacterial agents. QACs are extensively used in SARS-CoV-2-related sanitization in clinical and household settings. Similarly, due to the danger of secondary infections, antibiotic therapeutics are increasingly used as a component of COVID-19 treatment regimens, even in the absence of a bacterial infection diagnosis. The increased use of antibacterial agents as cleaners and therapeutics is anticipated to lead to novel resistances in the coming years.

Keywords: Applied Chemistry; Microbiology; Multi-Drug Resistant Organisms.

Graphical abstract

Figure 1

Antimicrobial resistance and COVID-19 mortalities (A) Projected global annual deaths due to antibiotic resistance by 2050 as compared with the most prevalent causes of mortalities in 2014 (O'Neill, 2014). (B) Annual mortalities due to influenza, pneumonia, and COVID-19 in the United States per 100,000 people. Data for 2021 is through the beginning of March (CDC, 2020).

Figure 2

Quaternary ammonium compound (QAC) resistance and structure (A) Overview of QAC resistance mechanism in S. aureus. Once a QAC enters the cell it engages with the negative transcriptional regulator QacR. Upon binding qacA is overexpressed, resulting in the production and incorporation of QacA efflux pumps on the cell surface to expel QACs. Homologous mechanisms occur in other organisms. (B) Structures of common QAC compounds (benzylalkonium chloride (BAC), cetylpyridinium chloride (CPC), didecyldimethylammonium chloride (DDAC)).

Figure 3

Antibiotic therapeutic resistance and bacterial co-infections (A) Overview of therapeutic resistance. (B) Structures of common classes of broad-spectrum antibiotics. (C) Mortalities in 2017 due to common bacterial infections (U.S. Department of Health and Human Services, 2019). These infections are prevalent as co-infections and secondary infections with SARS-CoV-2 (Zhu et al., 2020).