COVID-19 stalls progress made against antimicrobial resistance in U.S.

In 2020, the U.S. saw an increase in health care-associated, antimicrobial-resistant infections in hospitals, according to a CDC report published on July 12.

During the first year of the COVID-19 pandemic, resistant hospital-onset infections and deaths both increased significantly, the report said. Analysis of eight resistant infections found a 15% overall increase in hospital-onset resistant infections and deaths from 2019 to 2020 (Candida auris was not included in the hospital-onset rate calculation). Of note, rates of hospital-onset carbapenem-resistant Acinetobacter, antifungal-resistant C. auris, and carbapenem-resistant Enterobacterales increased by 78%, 60%, and 35%, respectively. Due to the pandemic, 2020 data were delayed or unavailable for nine of 18 antimicrobial resistance threats, including Clostridioides difficile, drug-resistant Neisseria gonorrhoeae, and drug-resistance Campylobacter.

The report also found that as COVID-19 cases increased in hospitals, so did antibiotic use. From March to October 2020, nearly 80% of patients hospitalized with COVID-19 received an antibiotic. While antibiotic use was lower overall in August 2021 compared to 2019, use of some antibiotics, such as azithromycin and ceftriaxone, had increased. About half of hospitalized patients received ceftriaxone, which was commonly prescribed with azithromycin. “This likely reflects difficulties in distinguishing COVID-19 from community-acquired pneumonia when patients first arrive at a hospital for assessment,” the report noted.

As of 2017, dedicated infection prevention and control efforts in the U.S. had contributed to reducing deaths from antimicrobial-resistant infections by 18% overall and by nearly 30% in hospitals; however, the pandemic has undone much of this progress, according to the report. A 2021 CDC analysis also reported significantly higher rates (after steady years of progress) for four out of six types of health care-associated infections (HAIs) in 2020, many of them resistant to antibiotics or antifungals.

“There were more and sicker patients during the pandemic who required more frequent and longer use of catheters and ventilators,” the report said. “This may have increased risk of HAIs and spread of pathogens, especially when combined with personal protective equipment and lab supply challenges, reduced staff, and longer lengths of stay.”

A 2021 ACP Hospitalist article covered the problem of HAIs rising during the pandemic.