Overprescribing antibiotics amid covid pandemic has helped fuel superbug infections and deaths, CDC says
The report analyzed antimicrobial resistance in the United States, focusing specifically on superbug infections that began in hospitals.
Public health efforts had reduced these resistant infections in hospitals by almost 30% between 2012 and 2017. But in 2020, the pandemic pushed hospitals, health departments, and communities “close to their breaking points,” CDC Director Rochelle Walensky wrote in the report.
Sicker patients have overwhelmed hospitals. They needed more frequent and longer use of medical devices, such as catheters and ventilators. Devices that break down the body’s natural protective barrier — the skin — increase the risk of infection.
Clinicians unfamiliar with the new covid-19 disease have relied heavily on antibiotics as the first option to treat patients with fever and shortness of breath – symptoms of the viral illness. From March 2020 to October 2020, nearly 80% of patients hospitalized with covid-19 received an antibiotic, according to the report. These life-saving drugs work against bacteria, not viruses. High levels of antibiotic prescription can expose patients to side effects and allow drug resistance to develop and spread.
Additionally, hospitals have faced severe shortages of personnel and personal protective equipment, especially the best quality N95 masks that offer the best protection. In some places, hospital staff have used parts purchased from Home Depot and craft stores to create protective face shields for workers. Overstretched staff struggled to follow infection prevention and control protocols, the report said. Many staff have been pulled from infection control to help care for covid-19 patients. This created a kind of double whammy: fewer staff to prevent infections treating more patients at risk for them.
“In addition to having devastating effects for the millions who contracted covid and the millions who died from it, the covid pandemic has had a profound and far-reaching impact on patient safety in the United States” , said Arjun Srinivasan. , the top CDC official who leads the agency’s prevention efforts to control superbugs. “One of the ripple effects of covid…is with these antibiotic resistant infections, very difficult to treat infections, in some cases incurable, with very high death rates.”
Some patients have recovered from their covid-19 illness, he said, only to face “a horrible outcome”: dying of a drug-resistant infection.
In 2020, more than 29,400 people died from antimicrobial resistant infections commonly associated with healthcare, according to the report. Of these, nearly 40% contracted the infection while in hospital. The other infections occurred outside of the hospital, including in nursing homes and other community health care facilities. Due to limited data, the CDC does not know how many people who died of superbug infections also had covid-19.
The CDC estimates that more than 2.8 million antimicrobial resistant infections occur in the United States each year, resulting in the death of more than 35,000 people. The total number of deaths in 2020 from these resistant infections could be much higher; monitoring and reporting of data has been reduced due to the pandemic.
Antimicrobial resistance occurs because bacteria are constantly evolving to fend off the drugs used to kill them. As they mutate, some bacteria develop the ability to fight off different antibiotics, multiplying and spreading resistance along the way. The more antibiotics are used in healthcare and agriculture, the less effective they become.
Antibiotic resistance is particularly deadly for patients in hospitals and nursing homes, and for those with weakened immune systems. But these hard-to-treat infections now threaten people undergoing common modern surgeries and therapies, such as knee replacements, organ transplants and cancer treatments.
Young, healthy people can get methicillin-resistant vaccine Staphylococcus aureus, or MRSA, infection on their skin. Women can get a urinary tract infection from another bad bug, ESBL-producing Enterobacteriaceae, which can no longer be treated with first-line oral medications and require intravenous antibiotics.
Hospital infections increased in the first year of the pandemic for three of the five resistant bacteria and fungi that pose the biggest threats to human health. The biggest leap was in carbapenem resistant Acinetobacter, bacteria that cause pneumonia and wound, blood and urinary tract infections, often in patients in intensive care units. In 2020, hospital infections for carbapenem resistant patients Acinetobacter jumped 78%, with 7,500 cases and 700 deaths, according to the report.
There has also been a 60% increase in hospital infections with a deadly superbug called candida auris, and a 35% increase in hospital infections with carbapenem-resistant enterobacteriaceae (CRE), also known as “nightmare bacteria.” CREs are a large group of bacteria of concern to patients who require catheters and other devices, long courses of certain antibiotics, or long hospital stays. Superbugs are resistant to all or nearly all antibiotics, kill up to half of patients who contract bloodstream infections, and can transfer their antibiotic resistance to other related bacteria, potentially rendering other bacteria incurable.
The CDC had previously classified the toll that 18 pathogens take on humans, classifying the threat of each as “urgent”, “serious” or “concerning”. But the agency lacks data for nine of these germs, many of which spread outside of hospital settings. They include sexually transmitted drug resistant gonorrhea and drug resistant gonorrhea Streptococcus pneumoniaeone of the main causes of bacterial pneumonia and meningitis.
Of the approximately 6,000 U.S. hospitals, about 2,400 voluntarily submit monthly antibiotic use data to the CDC, Srinivasan said; of these, about 1,100 also provide data on resistant bugs.
“We don’t have the data because our surveillance systems weren’t even able to work to provide us with this information during the pandemic,” Srinivasan said. “It should be just as alarming to people as the pathogens that have increased. It’s just as alarming when you don’t know.