Hospitalization-related resistant infections and deaths increased at least 15% in the first year of the COVID-19 pandemic, pushing back the progress made in the fight against antimicrobial resistance (AMR), according to a new report by the CDC.
“This report confirms what previous research has suggested: COVID-19 has not only increased the threat of antibiotic resistance; it has undone years of progress, and on a staggering scale,” said David Hyun, the director of The Pew Charitable Trusts Antibiotic Resistance Project.
“The magnitude of the damage is significant. There are steps we must take immediately to protect people and save lives, including strengthening systems to improve the way antibiotics are used, and enacting policies like the PASTEUR [Pioneering Antimicrobial Subscriptions to End Upsurging Resistance] Act that will stimulate the development of urgently needed new antibiotics. The need for action in the fight against this serious and growing public health threat has never been more urgent,” Mr. Hyun added.
Threat Within the Threat
The CDC analyzed the state of AMR in the United States immediately after the 2020 peaks of the pandemic. The data show an increase in resistant infections starting during hospitalization that the agency called “alarming.” The publication, titled “COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022,” found an increase in seven pathogens, including the following:
- 78% increase in carbapenem-resistant Acinetobacter;
- 32% increase in multidrug-resistant Pseudomonas aeruginosa;
- 14% increase in infections in vancomycin-resistant Enterococcus; and
- 13% increase in methicillin-resistant Staphylococcus aureus.
Antifungal-resistant threats also rose in 2020: Candida auris increased 60% overall, and other Candida species increased 26%.
Clostridioides difficile is the only healthcare-associated pathogen to improve in 2020, likely driven in part by changes in healthcare-seeking behavior that resulted in fewer antibiotics being prescribed.
By comparison, a 2019 report showed AMR infections falling by 27% from 2012 to 2017. These reductions continued in hospitals until the COVID-19 pandemic began.
The CDC data demonstrate significant surges in antibiotic use and difficulty in following infection prevention and control guidance during the pandemic. Hospitals experienced problems with personal protective equipment supplies, staffing shortages and longer patient stays. Staff also treated sicker patients who required more frequent and longer use of medical devices, such as catheters and ventilators.
Antibiotics were often the first treatment given to people who presented with pneumonia-like symptoms of fever and shortness of breath, even though many patients had SARS-CoV-2 infection, for which antibiotics are not effective. From March to October 2020, almost 80% of patients hospitalized with COVID-19 received an antibiotic.
Although some of this prescribing can be appropriate when risks for related bacterial or fungal infections are unknown, this high level of prescribing also can put patients at risk for side effects and create a pathway for resistance to develop and spread, according to the CDC.
The impact of the pandemic likely resulted in an increase of healthcare-associated, AMR infections, the CDC said. During the first year of the pandemic, more than 29,400 people died from AMR infections commonly associated with healthcare. Of this group, nearly 40% acquired the infection during a hospital stay.
Denise Cardo, MD, the director of the CDC’s Division of Healthcare Quality Promotion, said emphasis should be placed on expanding existing prevention strategies that have proven effective. “The 2021 launch of the Global AR Lab and Response Network and the Global Action in Healthcare Network is an example of how aggressively CDC is moving to combat antimicrobial resistance not only in the U.S., but in nearly 50 countries across the world.
“We made significant progress before the pandemic, and I’m confident that we will make significant progress going forward,” Dr. Cardo noted.
The agency said it remains committed to the U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria, and will move forward by addressing gaps in the public health system and exploring investments in U.S. healthcare infrastructure in the following key areas.
- Enhance data systems and sharing: expanding automation of electronic data to allow healthcare facilities and systems to have information they need about antibiotic use and AMR.
- Infection control: continuing to offer high-quality infection prevention and control training to every healthcare professional and to healthcare facilities beyond hospitals, such as nursing homes and other long-term care facilities.
- Antibiotic/antifungal use and access: optimizing antibiotic use across all healthcare settings and implementing the CDC’s Core Elements across healthcare settings.
- Environment and sanitation: expanding the capacity of the National Wastewater Surveillance System to collect AMR data from wastewater treatment plants and healthcare facilities, studying resistance in community and healthcare wastewater domestically and globally.
- Vaccines, therapeutics and diagnostics: enhancing interagency collaboration to accelerate research for developing new antibiotics, antifungals and therapeutics.
Daniel P. McQuillen, MD, FIDSA, the president of the Infectious Diseases Society of America, called for systemic changes. “This is no longer a future crisis but one that is at America’s doorstep and needs to be addressed now. Whenever there are high levels of hospitalizations, rates of antimicrobial-resistant infections and deaths will likely further increase unless we take steps to prevent them,” he said, adding that Congress must act.
This article is from the September 2022 print issue.