The Impact of COVID-19 on Antimicrobial Resistance in the US

This transcript has been edited for clarity.

A recent report from CDC shows that the United States has lost progress combating antimicrobial resistance, due in large part to effects of the COVID-19 pandemic. In hospitals alone, antimicrobial-resistant infections and deaths both increased at least 15% in 2020 compared to 2019. Most of these infections are preventable. CDC has many resources for healthcare providers like you to help stop these increases, protect patients, and preserve the effectiveness of the antibiotics and antifungals we have today.

Hello. I'm Arjun Srinivasan, deputy director for program improvement in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention. My CDC colleagues and I work to support your efforts to protect patients; protect healthcare personnel; and promote safety, quality, and value in both national and international healthcare delivery systems.

Many of us have worked alongside you during the COVID-19 pandemic and seen firsthand, or secondhand, not only the incredible challenges posed for patient care but also the heroic ways in which many of you stepped forward to care for those in need. The pandemic undoubtedly pushed providers, healthcare facilities, health departments, and communities near their breaking points. And while many facilities and systems have stabilized, we know that COVID-19 remains a major issue for healthcare delivery.

Thank you for your service and dedication. Thank you for your stamina. Thank you for showing up, for putting yourself in harm's way to help your community, and for your willingness to serve even when we didn't have all the answers. Above all, thank you for your patience. You have been asked to bear so much responsibility. I'm here today to remind us all of important actions we can take to maintain our vigilance and prevent the spread of another threat: antimicrobial resistance.

This summer, CDC released a special report on how COVID-19 affected the nation's progress on antimicrobial resistance.

Antimicrobial resistance (or AR) is when organisms like bacteria and fungi can't be effectively treated with the usually recommended agents — making them harder, and sometimes impossible, for us to treat.

Infections/Deaths

As you know, hospitals saw a much different inpatient population in 2020 than before the pandemic. Hospitals were inundated with high numbers of sicker patients who had longer lengths of stay and more and longer use of invasive devices like ventilators and catheters. The increased risks for healthcare-associated infections (or HAIs), of course, drive resistance. And that, combined with factors like limited access to personal protective equipment, lab supply challenges, and reduced staff levels, may have kept healthcare providers from implementing prevention strategies we know work.

These HAIs are often caused by resistant pathogens such as carbapenem-resistant Acinetobacter, multidrug-resistant Pseudomonas aeruginosa, vancomycin-resistant Enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and Candida auris. Overall, resistant infections starting in hospitals increased by 15% in 2020 compared to 2019.

This increase is a significant blow, representing at least 29,400 lives lost from antimicrobial-resistant infections commonly associated with healthcare. The overall burden of antimicrobial resistance is likely much higher, but the pandemic created data gaps. In a 2021 analysis, CDC reported much of the same: that US hospitals saw significantly higher rates of four out of six types of healthcare-associated infections — HAIs — during the first year of the pandemic after years of steady reductions. The rising tide of HAIs will continue to escalate development of antimicrobial resistance unless we act urgently.

Antibiotic Use

In addition to a sicker patient population and strains on implementing infection control, CDC data also show that when COVID-19 cases increased in hospitals in 2020, so did antibiotic use. Studies have shown that antibiotics were frequently started on admission for most patients with COVID-19, even though very few of those patients had bacterial infections. This was especially challenging early in the pandemic as we struggled to learn about management approaches and to distinguish COVID-19 from bacterial community-acquired pneumonia when patients first arrived at hospitals for assessment.

From March 2020 to October 2020, almost 80% of patients hospitalized with COVID-19 received an antibiotic. Approximately half of hospitalized patients received ceftriaxone, which was commonly prescribed with azithromycin. We now know that many of these were not necessary and were not beneficial to the patients who got them.

Those of us who have the power to prescribe antibiotics and antifungals must remember: Any time these drugs are used, they can contribute to the development of resistance. Just as important, needless use doesn't benefit the patient but puts them unnecessarily at risk for side effects like allergic reactions, toxicity that affects organ function, and Clostridioides difficile infection, which kills nearly 50,000 people per year.

We have learned so much about diagnosing and managing COVID-19 in the past 2 years, and we have seen successful approaches to improving antibiotic use in patients with COVID-19. Our challenge is to continue to apply what we've learned as we continue to treat patients into the future.

The good news is, we know what works to stop many of these infections from ever happening: basic infection prevention and control practices. In fact, from 2012 to 2017, dedicated infection prevention and control efforts, and improved use of antibiotics and antifungals, contributed to reduced deaths from antimicrobial-resistant infections by nearly 30% in US hospitals. The COVID-19 pandemic reversed some of this progress. We must refocus our attention on protecting patients by preventing infections and improving antibiotic use while patients are receiving healthcare.

I'm asking you to remember that antimicrobial resistance was one of the major threats to the safety of our patients before the pandemic. It is not slowing down and has gotten worse while we've focused our efforts on COVID-19. We have heard from so many of you about the heartbreaking experience of saving a patient from COVID-19, only to lose them to a healthcare-associated, antibiotic-resistant infection. And while new drugs will help address this challenge, we all know that new antibiotics will not be the primary solution to the challenge of resistance. We have to focus on preventing infections and improving antibiotic use.

Here are three steps your hospital can take to protect patients from hard-to-treat and untreatable infections and to combat antimicrobial resistance.

First: Follow infection prevention and control practices with every patient, every time.

This includes keeping your hands clean between patients, asking patients if they've recently received healthcare to identify who may be at higher risk for infections, and staying informed of current outbreaks.
Follow recommendations to prevent device- and procedure-related infections, and make sure that environmental cleaning practices are followed for all patient settings.
CDC also has new infection control training available for all healthcare workers through CDC's Project Firstline. Project Firstline has materials you can share with your staff and colleagues so they can recognize infection risks and apply actions consistently and with confidence to protect patients from HAIs and antimicrobial resistance.

Second: Improve how you prescribe antibiotics and antifungals.

Follow clinical and treatment guidelines.
Perform appropriate diagnostic and susceptibility tests to guide antibiotic and antifungal therapy, including correct drug, dose, and duration.
Watch for signs and symptoms of sepsis.
Report antibiotic use and antimicrobial resistance data to CDC's National Healthcare Safety Network and use that data to inform improvements.

Third: Encourage your patients to prevent infections and stay up-to-date on vaccinations.

Vaccines help slow antimicrobial resistance by stopping the spread of bacteria and reducing antibiotic and antifungal use.
CDC also has resources on how to be a safe patient.

Thank you for continued commitment to patient safety. As Dr Walensky, our agency director, said recently, "Please do not neglect yourselves as you continue to take care of others." Our nation could not have weathered the storm without you.

I know that you will be at the forefront, again, as we resharpen our focus on prevention of antimicrobial resistance.

Thank you for tuning in to this CDC expert video commentary on Medscape.

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