key: cord-0883716-s78qlhhm
authors: Chang, Chien-Yi; Chan, Kok Gan
title: Underestimation of co-infections in COVID-19 due to non-discriminatory use of antibiotics
date: 2020-07-03
journal: J Infect
DOI: 10.1016/j.jinf.2020.06.077
sha: 4a82ed8a54b5b93e8351e620a8e49b8c77bdba4d
doc_id: 883716
cord_uid: s78qlhhm

nan

Coronavirus disease 2019 pandemic is causing huge impacts on health and social care systems globally. Several health authorities have published their guidelines for COVID-19 diagnosis and treatment including the administration of antimicrobial agents. Both guidelines for COVID-19 management by the UK National Institute for Health and Care Excellence and by World Health Organization discourage antibiotic therapy or prophylaxis for suspected COVID-19 patients and confirmed patients with mild symptoms, but suggest to prescribe antibiotics for suspicious bacterial infections. 1, 2 The US National Institutes of Health guideline 3 indicates that no sufficient data supports empirical antibiotic therapy, but acknowledges that some clinicians routinely administer broad-spectrum antibiotics to all patients with moderate or severe hypoxemia. The latest It is unclear that the reported low co-infection rate is the result of large scales of empirical antimicrobial administration or the limitation of the overwhelmed clinical examinations in health systems during the pandemic. We concern the underestimation of the co-infections in COVID-19 patients, especially those on invasive mechanical ventilation support. However, we are also aware of the long-term impact of the development of antimicrobial resistance due to unnecessary usage of antimicrobial agents. We urge to re-establish stewardship of antimicrobial therapy by systematic surveillance on antimicrobial usage and co-infections in COVID-19 patients. Future development in fast diagnosis for infectious agents based on genomics or proteomics identification will provide timely and accurate information for disease management. It is essential to develop evidence-based guidelines for responding the potential second wave of COVID-19 or future pandemics.

The authors declare that they have no competing interests.

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