Beyond COVID-19—a paradigm shift in infection management?
Authors: Maria J G T Vehreschild, Evelina Tacconelli, Christian G Giske, Andreas Peschel
Journal: The Lancet Infectious Diseases (2020)

The health and economic impact of multidrug-resistant (MDR) bacteria has continuously grown over the past years, reaching an estimated peak of approximately 700 000 attributable deaths per year.1O'Neill J Tackling drug-resistant infections globally: final report and recommendations. Wellcome Trust, London2016Google Scholar Neglected hygiene, poor compliance with infection control procedures, inappropriate antimicrobial use, and insufficient availability of diagnostics and new effective antibiotics have contributed to this inglorious global record.2Clancy CJ Nguyen MH It's worse than we thought: the US market for novel Gram-negative antibiotics.Lancet Infect Dis. 2020; 20: 1009-1010Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 3Laxminarayan R Van Boeckel T Frost I et al.The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later.Lancet Infect Dis. 2020; 20: e51-e60Summary Full Text Full Text PDF PubMed Scopus (152) Google Scholar Despite these alarming figures, infection prevention and treatment have not been considered top priorities on the agendas of most industrialised countries. This mindset changed abruptly with the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).4Javelle E Raoult D COVID-19 pandemic more than a century after the Spanish flu.Lancet Infect Dis. 2020; (published online Aug 11.)https://doi.org/10.1016/S1473-3099(20)30650-2Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar The exponential expansion of the pandemic catapulted COVID-19 to the top of national and international priority lists, and people judge the performance of their political leaders on the basis of success in containing the pandemic. The more we realise how much SARS-CoV-2 has changed the world, the more we question the suitability of our prevention, management, and drug development strategies with respect to other major pathogens. Notably, the population at risk of severe COVID-19, including elderly, immunocompromised, and multimorbid people, largely overlaps with the population at risk of health-care-associated infections (HAIs). Even among high-income countries, there are substantial differences in MDR infection rates, varying between close to zero and more than 50% depending on national strategies and health economic investments.5ECDCEuropean Antimicrobial Resistance Surveillance Network (EARS-Net).https://www.ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/ears-netDate accessed: September 24, 2020Google Scholar Will high-income societies continue to accept substantial numbers of avoidable deaths caused by HAIs while risking an unprecedented economical and societal crisis to protect the same risk group from COVID-19? Can we import actions from the COVID-19 experience into the HAI field? A combination of strategies, ranging from extended MDR surveillance and clinical guidelines to the development of concepts for remediation of MDR reservoirs and effective incentives for antibiotic development programmes, could strongly limit the burden of HAIs.1O'Neill J Tackling drug-resistant infections globally: final report and recommendations. Wellcome Trust, London2016Google Scholar, 3Laxminarayan R Van Boeckel T Frost I et al.The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later.Lancet Infect Dis. 2020; 20: e51-e60Summary Full Text Full Text PDF PubMed Scopus (152) Google Scholar, 6Tacconelli E Autenrieth IB Peschel A Fighting the enemy within.Science. 2017; 355: 689-690Crossref PubMed Scopus (13) Google Scholar The necessary efforts against nosocomial infections will be substantial but marginal compared with the current activities against COVID-19. The pandemic has changed our ways of thinking and paved the way for more efficient measures against other types of infections; we have learned to deal with epidemiological big data more efficiently, new research networks for innovative research are in place, venture capital will be more easily available for development programmes, and public opinions will back stronger governmental commitments to tackling HAIs. The time has come for a paradigm shift in infection management. MJGTV reports grants and personal fees from 3M, Astellas Pharma, DaVolterra, MaaT Pharma, and Merck; grants from Biontech, Evonik, Gilead Sciences, Glycom, Immunic, Seres Therapeutics, Takeda Pharmaceutical, Farmak International Holding GmbH, and SocraTec R&D GmbH; and personal fees from Basilea, Pfizer, Organobalance, Alb Fils Kliniken GmbH, Arderypharm, and Ferring, outside the submitted work. CGG reports personal fees from 1928 Diagnostics and Q-linea, outside the submitted work. AP has patent PSC/EP2016/056358 issued. ET declares no competing interests.