Antimicrobial Resistance, COVID Symptoms, RNA Viruses, Treatment Guidelines

Pandemic May Have Accelerated Antimicrobial Resistance1

Higher rates of antimicrobial resistance (AMR) in bacterial infections per 1000 hospital admissions were found in hospitalized patients tested for SARS-CoV-2 during the COVID-19 pandemic than in hospitalized patients before the pandemic. These findings emerged from a multicenter, retrospective, cohort study that evaluated the impact of the pandemic on AMR.1 The study included all adults to 271 US hospitals in 2 study periods: before the pandemic (from July 1, 2019, through February 29 , 2020) and during the pandemic (from March 1, 2020, through October 30, 2021).

The rate of AMR per 1000 admissions before the pandemic was 3.54 vs 3.47 during the pandemic. However, in patients tested for SARS-CoV-2, the rate of AMR per 1000 admissions was 4.92 in those with a positive result and 4.11 in those with a negative result, and chi-square testing comparing either of these rates with the pre- pandemic rate found that both sets of rates were significantly different at the P < .001 level.

Possible contributors to the rise in AMR include an increase in antibiotic use to treat COVID-19 patients and disrupted infection control procedures during the pandemic.

Frequency of Common Long COVID Symptoms2

One year after COVID-19 infection, 59.5% of individuals still had at least one COVID-19 associated symptom, according to the results of a recent cohort study. The study also found that symptoms that did not resolve after 15 weeks were likely to last at least a year.

In addition to a detailed long questionnaire assessing whether they had any of 64 symptoms of COVID, the 289 total participants also completed questionnaires on sleep quality and the effect of respiratory symptoms on quality of life. Their responses indicated that 54.2% had ongoing trouble sleeping, and 12.9% had respiratory symptoms that were impairing their quality of life. The most common symptoms included fatigue, eye tiredness, shortness of breath and irritability.

“Participants with initial moderate or severe COVID-19 disease incised more frequently at least 1 symptom or sleep problems than initially asymptomatic participants,” noted Aurelie Fischer, MD, Luxembourg Institute of Health (Strassen, Luxembourg) and colleagues.

In addition, 14.2% of the study group felt they could not live with their current level of health long term. However, the likelihood of this response did not vary by initial disease severity.

Supplements for Respiratory Viruses3

A combination of zinc, copper, and 4 flavonoids may provide protection against 3 respiratory RNA viruses by inhibiting genome replication levels.

The combination included zinc picolinate as well as copper to avoid creating an imbalance between zinc and copper ions and to improve efficacy. The flavonoids included epigallocatechin-3-gallate (EGCG), quercetin, taxifolin or dihydroquercetin, and naringenin. These commonly used polyphenols act as zinc ionophores to transport zinc cations through the cell membrane.

Researchers confirmed the safety of each component and their combinations in cultured cells by using an in vitro cell viability assay. They then used fluorescence-activated cell sorting and the quantitative polymerase chain reaction to evaluate the antiviral activity of the combinations. Testing revealed that the combinations inhibited viral replication by 50% to 90%; the viruses used were human coronavirus OC43, which causes the common cold, an H1N1 influenza A virus, and the human metapneumovirus.

“Our results offer an orally bioavailable therapeutic approach that is non-toxic, naturally sourced, applicable to numerous RNA viruses, and potentially insensitive to new mutations and variants,” researchers. They hope to use their findings to cover a wide range of respiratory illness, including COVID-19.

New COVID-19 Treatment Guidelines Issued in April 20224

The National Institute of Health’s COVID-19 Treatment Guidelines Panel issued several major revisions during April 2022.

The revised guideline lists ritonavir-boosted nirmatrelvir (Paxlovid) as the preferred therapy for nonhospitalized patients with mild to moderate COVID-19 who are at high risk of progressing to severe disease, followed by remdesivir. Alternative therapies for use only when neither preferred therapy is available, feasible to use, or clinically appropriate are bebtelovimab and molnupiravir.

When none of the preferred or alternative therapies are available, feasible to use, or clinically appropriate, sotrovimab may be used only in regions where the Omicron BA.2 subvariant is not dominant. This recommendation is based on the finding that the in vitro activity of sotrovimab against this subvariant is substantially reduced compared with its activity against earlier variants.

In addition, the panel recommends against the use of ivermectin, convalescent plasma collected before the emergence of Omicron, and convalescent plasma for hospitalized, immunocompetent patients.

—Ellen Kurek

References:

  1. Bauer KA, Puzniak LA, Yu KC, et al. Multi-centre evaluation of the COVID-19 pandemic’s impact on antimicrobial resistance across United States hospitals. Presented at: European Congress of Clinical Microbiology & Infectious Diseases (ECCMID); April 24, 2022; Lisbon, Portugal. https://drive.google.com/file/d/1vU15cRuSWA687mI5rPnv2M0QoI_nLzCe/view
  2. Fischer A, Zhang L, Elbeji A, Fagherazzi G. Frequencies and impact of long COVID symptoms one year after the acute phase: results from the prospective predi-COVID cohort study. Presented at: ECCMID; April 25, 2022;
    Lisbon, Portugal.
    https://drive.google.com/file/d/1gxAy_xU9bJDyCBNzBQqxwzDdLX48V2F0/view
  3. Kreiser T, Zaguri D, Sachdeva S, et al. Inhibition of respiratory RNA viruses by a composition of ionophoric polyphenols with metal ions. Pharmaceuticals. 2022;15:377-390. doi:10.3390/ph15030377
  4. National Institutes of Health. COVID-19 Treatment Guidelines; what’s new in the guidelines. News release. Updated April 29, 2022. Accessed May 2, 2022. https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/whats-new/

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