Antimicrobial resistance: A challenge awaiting the post-COVID-19 era

Abstract

Microbe exposure to pharmaceutical and non-pharmaceutical agents plays a role in the development of antibiotic resistance. The risks and consequences associated with extensive disinfectant use during the COVID-19 pandemic remain unclear. Some disinfectants, like sanitizers, contain genotoxic chemicals that damage microbial DNA, like phenol and hydrogen peroxide. This damage activates error-prone DNA repair enzymes, which can lead to mutations that induce antimicrobial resistance. Public health priority programs that have faced drug-resistance challenges associated with diseases, such as tuberculosis, HIV, and malaria, have given less attention to risks attributable to the COVID-19 pandemic. Pathogen-specific programs, like the directly observed treatment strategy designed to fight resistance against anti-tuberculosis drugs, have become impractical because COVID-19 restrictions have limited in-person visits to health institutions. Here, we summarized the key findings of studies on the current state of antimicrobial resistance development from the perspective of current disinfectant use. Additionally, we provide a brief overview of the consequences of restricted access to health services due to COVID-19 precautions and their implications on drug resistance development.

Keywords: AMR; Bacteria; COVID-19; Disinfectants; non-pharmaceuticals; pharmaceuticals.

Figure 1

The main drivers of antimicrobial resistance. Inappropriate use of antimicrobial agents for clinical and non-clinical applications accelerates the rate at which drug resistance develops.

Figure 2

Classical curve showing biphasic killing by antibiotics that leaves a fraction of the bacterial subpopulation that enters into dormancy or becomes resistant. Pharmaceutical and non-pharmaceutical agents, such as antibiotics, sanitizers, and stress conditions, affect (A) actively replicating bacteria (green), which leads to (B and C) depletion of the sensitive clones (grey). A small proportion of surviving bacteria enters into (E) a dormant, persistent state (light green) or (D) a resistant state (red). The dormant, persistent fraction reactivates when antibacterial agents are removed (G), and become susceptible. The resistant subpopulation continues to multiply in the presence of the antimicrobial agent(s) that are designed to kill them (F).