Years of advancement in the United States’ fight against antimicrobial resistance (AR) were set back by the COVID-19 epidemic.
The COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022 report from the Centers for Disease Control and Prevention (CDC) comes to the conclusion that the threat of antibiotic-resistant infections is not only still present but has grown worse, with resistant hospital-onset infections and deaths both increasing by at least 15% during the first year of the pandemic.
This setback must be transitory and can be. Antimicrobial resistance won’t end if we let our guard down; there is no time to spare, as the COVID-19 pandemic has amply demonstrated, according to Michael Craig, MPP, Director of the CDC’s Antibiotic Resistance Coordination & Strategy Unit.
“To keep our country safe, the greatest way to prevent a pandemic brought on by an infection that is resistant to antibiotics is to identify gaps and invest in prevention.”
In the study, the Centers for Disease Control and Prevention (CDC) examined the level of antibiotic resistance in the US shortly after the COVID-19 pandemic’s peak in 2020.
According to the data, resistant infections that start while a patient is hospitalized increased alarmingly from 2019 to 2020, climbing by a total of 15% among seven pathogens.
There were an increase in the following pathogens:
carbapenem-resistant Multidrug-resistant Acinetobacter infections have increased by 78% Infections caused by Pseudomonas aeruginosa have increased by 32% and are now vancomycin-resistant Methicillin-resistant enterococcus (VRE) infections have increased by 14%. Staphylococcus aureus (MRSA) infections have increased by 13%.
Threats that are resistant to antifungal medications grew in 2020 as well, including Candida auris, which had an overall increase of 60%, and Candida species (other than Candida auris), which saw an increase in infections in hospitals of 26%.
A 2019 research, in contrast, highlighted significant nationwide reductions in hospitals, where antimicrobial-resistant illnesses decreased by 27% from 2012 to 2017; statistics show these reductions persisted in hospitals until the pandemic started.
The only healthcare-associated pathogen to show improvement in 2020 is Clostridioides difficile, probably as a result of changes in how people seek medical attention.
According to CDC data, there have been considerable increases in the use of antibiotics in U.S. hospitals as well as challenges in adhering to infection prevention and control recommendations, both of which are essential for stopping the spread of illnesses that are resistant to antibiotics.
Hospitals saw difficulties with the availability of personal protective equipment during the epidemic, as well as staffing shortages and extended patient stays.
Additionally, hospitals cared for sicker patients who needed to use ventilators and catheters more frequently and for longer periods of time.
The pandemic’s effects probably contributed to a rise in infections linked to healthcare and antibiotic resistance.
More than 29,400 persons died from diseases that are frequently linked to healthcare during the first year of the pandemic.
Nearly 40% of patients contracted the virus while they were receiving medical care.
Although data gaps brought on by the pandemic make it difficult to make that conclusion, the total national burden of mortality from AR may be significantly higher.
A lot of clinics and healthcare facilities cut back on services, saw fewer patients, or shut their doors entirely in response to COVID-19’s issues, according to the limited information the CDC has on the spread of antibiotic-resistant diseases in the community.
Nine of the 18 illnesses mentioned in the CDC’s 2019 Antibiotic Resistance Threats Reports had delayed or unavailable data.
The CDC estimated that more than 2.8 million antimicrobial-resistant infections occur in the United States each year, with more than 35,000 people dying as a result, in the 2019 report, the last year for which comprehensive healthcare and community data were available to calculate.
During the epidemic, historical advancements in antibiotic prescribing were also undone.
Even though these symptoms frequently indicated the viral infection COVID-19, for which antibiotics are ineffective, antibiotics were frequently the first line of treatment given to patients who presented with pneumonia-like symptoms of fever and shortness of breath.
Nearly 80% of individuals hospitalized with COVID-19 from March 2020 to October 2020 received an antibiotic.
This high level of medication can put patients at risk for side effects and open a door for resistance to develop and spread, even while part of this dosing may be reasonable when risks for associated bacterial or fungal infections are unknown.
Despite the epidemic, over 90% of U.S. hospitals had an antibiotic stewardship policy in line with the CDC’s Core Elements of Hospital Antibiotic Stewardship in 2020, which may have helped to lower the number of Clostridioides difficile infections.
Numerous antibiotic resistance initiatives throughout the pandemic helped to halt the spread of COVID-19.
For instance, the CDC’s AR Solutions Initiative provided infection control expertise to healthcare facilities, many of which were nursing homes, to perform more than 14,000 outbreak consultations; the CDC’s AR Lab Network sequenced more than 4,700 SAR-CoV-2 genomes; and the CDC’s NHSN, which supports COVID-19 data collection in hospitals and nursing homes by adding new capabilities.
Denise Cardo, MD, Director of CDC’s Division of Healthcare Quality Promotion, stated that “we need to emphasize and expand the application of the effective preventative methods that are already in CDC’s toolbox to all healthcare facilities.”
“An illustration of how aggressively CDC is moving to tackle antimicrobial resistance is the 2021 launch of the Global AR Lab and Response Network and the Global Action in Healthcare Network.
This initiative will affect over 50 countries worldwide in addition to the United States.
Before the epidemic, we made great progress, and I have no doubt that we will continue to do so in the future.
CDC remains committed to the U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) with prevention and preparedness as its top priorities.
Moving forward, CDC will address weaknesses in the public health system and consider investments in the country’s healthcare infrastructure in the following crucial areas:
Enhance Data Systems and Sharing: Under NHSN, electronic data automation is being expanded to give healthcare institutions and systems access to the data they require regarding antibiotic use and antimicrobial resistance.
This also entails collaborating on well-established networks like the CDC’s AR Lab Network in times of crisis, leveraging telemedicine to track down contacts, and supporting continuous laboratory equipment and supplies for patient care and infection control.
Continue to provide every healthcare professional and healthcare facility outside of hospitals, such as nursing homes and other long-term care facilities, with top-notch infection prevention and control training, like Project Firstline.
The general population must also be informed on how to practice infection prevention in the neighbourhoods where they live and work.
Optimizing antibiotic usage across all healthcare settings and adopting the CDC’s Core Elements throughout healthcare settings.
Antibiotic/Antifungal Use and Access.
Additionally, promoting the best tracking and usage of antibiotics and antifungals for agriculture and companion animals.
Environment and Sanitation: Increasing the National Wastewater Surveillance System’s ability to gather data on antimicrobial resistance from wastewater treatment facilities and healthcare institutions, as well as researching resistance in domestic and international community and hospital wastewater.
Additionally, this entails enhancing global capabilities to combat environmental antimicrobial resistance and track it throughout One Health.
Enhancing interagency cooperation in the areas of vaccines, medicines, and diagnostics will speed up the search for novel antibiotics, antifungals, and therapies.
Working with the Food and Drug Administration, for instance, to find approaches to enhance the accessibility of decolonization goods.
This involves encouraging the use of vaccines to stop illnesses, delay the spread of resistance, and lessen the need for antibiotics, as well as creating a platform for vaccine data to guide the creation of new vaccines.
The CDC is and will continue to be a leader in the fight against antibiotic resistance.
The fight will now take on a newfound zeal in prevention-focused public health efforts to keep the country safe, even if the pandemic largely erased the advances in infection prevention and control made in the previous decade.