COVID-19: Why biocide overuse needs to be addressed to tackle AMR

Excessive use of biocides can be a potential threat that could drive AMR further, underlined a WHO editorial 

By Rajeshwari Sinha
Published: Friday 03 July 2020

A wide-scale use of biocides for personal and environmental disinfection could be another propellant for antimicrobial resistance (AMR) —  a global public health threat and a chronic pandemic in itself.

The World Health Organization (WHO) in its most recent bulletin highlighted the risks linked with overuse of antibiotics in the novel coronavirus disease (COVID-19) patients, and how the issue of AMR could be tackled. The editorial was authored by experts at the Department of Global Coordination and Partnership on Antimicrobial Resistance and the Antimicrobial Resistance Division at WHO. 

In the absence of medicine or vaccine for COVID-19, following hygiene practices is how the world can fend for itself. Key to this is hand-washing and regular sanitising, which has led to a significant rise in use of soaps, sanitisers, surface disinfectants and floor cleaners.

Overuse of antibiotics in COVID-19 patients to stave off secondary bacterial infections are among factors driving AMR. But the link between biocides and AMR in the outbreak has started gaining attention only recently.

Biocides are used to destroy or control any harmful organism by chemical or biological means. The examples include disinfectants or antiseptics with common ingredients like alcohol, hydrogen peroxide, surfactants, triclosan, sodium hypochlorite, chlorhexidine and quaternary ammonium compounds.

According to the authors, excessive use of biocides can be a potential threat that could drive AMR further, since long-term exposure to sub-lethal levels of such agents — both in healthcare and non-healthcare settings — can aid the selection of resistant bacteria.

It may also increase risk of cross-resistance to antibiotics, which treat particularly gram-negative bacteria increasingly resistant to most available antibiotics.

 “While appropriate use of biocides can help in infection prevention and control, a negative impact on antimicrobial resistance cannot be ruled out,” said Haileyesus Getahun, director, Global Coordination and Partnership on AMR, WHO and lead author of the editorial.

“There is emerging evidence that low level exposure of biocides in sanitisers and disinfectants could contribute to growing drug resistant pathogens in the environment”, he added. 

Another review on the global implications of COVID-19 outbreak on AMR, published recently in May 2020 in Frontiers in Microbiology, discussed the possibility of higher concentration of biocides in wastewater treatment plants and receiving waters due to their high levels of usage during the pandemic, thereby adding to the pool of AMR causing determinants in the environment.

Getahun and co-authors proposed an integration of necessary stewardship measures across the broader health system as part of the global response to COVID-19.

With respect to the use of biocides for disinfection purposes, they called for “maximum caution”. Biocidal agents likely to have no or low selection pressure for antibiotic resistance should be prioritised for use.  

This also highlights the need for urgent research that can assess the impacts of such wide-scale use of biocides for disinfection in the short- and long-term, their linkages with cross resistance to antimicrobials and other potential alternatives for disinfection.

Additional measures recommended in the editorial comprised increasing clinical competence of health workers to enable correct COVID-19 diagnosis, including that of superimposed bacterial or fungal infection; ensuring continuous delivery of health services and access to affordable antimicrobials and vaccines; improving testing methods; and increasing testing facilities for quicker turn-around time.  

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