Coronavirus disease 2019 (COVID-19) arose at a time of great concern about antimicrobial resistance (AMR). No studies have specifically assessed COVID-19-associated superinfections or AMR. Based on limited data from case series, it is reasonable to anticipate that an appreciable minority of patients with severe COVID-19 will develop superinfections, most commonly pneumonia due to nosocomial bacteria and Aspergillus. Microbiology and AMR patterns are likely to reflect institutional ecology. Broad-spectrum antimicrobial use is likely to be widespread among hospitalized patients, both as directed and empiric therapy. Stewardship will have a crucial role in limiting unnecessary antimicrobial use and AMR. Congressional COVID-19 relief bills are considering antimicrobial reimbursement reforms and antimicrobial subscription models, but it is unclear if these will be included in final legislation. Prospective studies on COVID-19 superinfections are needed, data from which can inform rational antimicrobial treatment and stewardship strategies, and models for market reform and sustainable drug development.

Clancy CJ, Nguyen MH

Clin Infect Dis. 2020 May 1:ciaa524. doi: 10.1093/cid/ciaa524.

The provisional EULAR recommendations address several aspects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus, and the disease caused by SARS-CoV-2, COVID-19 and are meant for patients with rheumatic and musculoskeletal diseases (RMD) and their caregivers. A task force of 20 members was convened by EULAR that met several times by videoconferencing in April 2020. The task force finally agreed on five overarching principles and 13 recommendations covering four generic themes: (1) General measures and prevention of SARS-CoV-2 infection. (2) The management of RMD when local measures of social distancing are in effect. (3) The management of COVID-19 in the context of RMD. (4) The prevention of infections other than SARS-CoV-2. EULAR considers this set of recommendations as a 'living document' and a starting point, which will be updated as soon as promising new developments with potential impact on the care of patients with RMD become available.

Landewé RB, Machado PM, Kroon F, Bijlsma HW, Burmester GR, Carmona L, Combe B, Galli M, Gossec L, Iagnocco A, Isaacs JD, Mariette X, McInnes I, Mueller-Ladner U, Openshaw P, Smolen JS, Stamm TA, Wiek D, Schulze-Koops H

Ann Rheum Dis. 2020 Jul;79(7):851-858. doi: 10.1136/annrheumdis-2020-217877. Epub 2020 Jun 5.

INTRODUCTION: Acral lesions, mainly chilblains, are the most frequently reported cutaneous lesions associated with COVID-19. In more than 80% of tested patients, nasopharyngeal swabs were negative on RT-PCR for SARS-CoV-2 when performed, and serology was generally not performed.

MATERIALS AND METHODS: A national survey was launched on March 30, 2020 by the French society of dermatology asking physicians to report cases of skin manifestations in patients with suspected or confirmed COVID-19 by using a standardized questionnaire. We report the results for acral manifestations.

RESULTS: We collected 311 cases of acral manifestations (58.5% females, median age 25.7 years [range 18-39]). The most frequent clinical presentation (65%) was typical chilblains. In total, 93 cases (30%) showed clinical suspicion of COVID-19, 67 (22%) had only less specific infectious symptoms, and 151 (49%) had no clinical signs preceding or during the course of acral lesions. Histology of skin biopsies was consistent with chilblains (n= 26/29). Twelve patients showed significant immunological abnormalities. Ten patients were positive among the 150 (48%) who were tested (RT-PCR and/or serology). Seven of 121 RT-PCR-tested patients were positive and 5 of 75 serology-tested patients were positive (IgG) among them RT-PCR and serology were both positive for two patients. Seven of 121 RT-PCR-tested patients were positive for SARS-CoV-2 (6%), and 5 of 75 serology-tested patients had IgG anti- SARS-CoV-2 (7 %). Tested and untested patients or those with and without confirmed COVID-19 did not differ in age, sex, history or acral-lesion clinical characteristics. CONCLUSION: The results of this survey do not rule out that SARS-CoV-2 could be directly responsible for some cases of chilblains but found no evidence of SARS-CoV-2 infection in large majority of patients with acral lesions during the COVID-19 lockdown period in France.