The COVID-19 pandemic pushed back years of progress in the fight against antimicrobial resistance (RA) in the United States. The Centers for Disease Control and Prevention (CDC) report, COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022, concludes that the threat of antimicrobial-resistant infections is not only present, but it has gotten worse; with resistant. hospital infections and deaths increased by at least 15% during the first year of the pandemic.
This setback can and should be temporary. The COVID-19 pandemic has unequivocally shown us that antimicrobial resistance will not stop if we lower our guard; there is no time to lose. The best way to prevent a pandemic caused by an antimicrobial-resistant pathogen is to identify gaps and invest in prevention to keep our nation safe. “
Michael Craig, MPP, director of the CDC Antibiotic Resistance Coordination and Strategy Unit
In the report, the CDC analyzed the state of antimicrobial resistance in the United States immediately after the peaks of the 2020 COVID-19 pandemic. The data show an alarming increase in resistant infections that start during the hospitalization, with an overall growth of 15% from 2019 to 2020 among seven pathogens. Increases in specific pathogens include:
- Carbapenem-resistant acinetobacter: 78% increase in infections,
- Pseudomonas aeruginosa resistant to multiple drugs: 32% increase in infections,
- Vancomycin-resistant enterococcus (VRE): 14% increase in infections and
- Methicillin-resistant Staphylococcus aureus (MRSA): 13% increase in infections.
Antifungal-resistant threats also increased in 2020, including Candida auris, which increased by 60% overall, and Candida species (excluding Candida auris), with a 26% increase in hospital infections. In comparison, in a 2019 report, significant national reductions were made in hospitals, where antimicrobial-resistant infections fell 27% between 2012 and 2017; The data show that these reductions continued in hospitals until the pandemic began. Clostridioides difficile is the only healthcare-associated pathogen that has improved by 2020, likely driven in part by changes in health research behavior.
In U.S. hospitals, CDC data show significant increases in antibiotic use and difficulties in following infection prevention and control guidelines, which are key to preventing antimicrobial-resistant infections and their spread. During the pandemic, hospitals experienced challenges in providing personal protective equipment, staff shortages, and longer patient stays. Hospitals also treated sick patients who required more frequent and longer use of medical devices such as catheters and ventilators. The impact of the pandemic likely led to an increase in healthcare-associated antimicrobial-resistant infections.
During the first year of the pandemic, more than 29,400 people died from antimicrobial-resistant infections commonly associated with health care. Of these, nearly 40% had the infection while in the hospital. The total national burden of AR deaths may be much higher, but the data gaps caused by the pandemic make this analysis difficult. The CDC has limited data on the spread of antimicrobial-resistant infections in the community; many clinics and health centers had limited services, cared for fewer patients, or closed their doors completely in the face of the challenges of COVID-19. Data are not available or have been delayed for nine of the 18 pathogens listed in CDC’s 2019 reports on antibiotic resistance threats.
In the 2019 report, the last year that comprehensive and community health data were available to calculate, the CDC estimated that more than 2.8 million antimicrobial-resistant infections occur in the U.S. each year. with the death of more than 35,000 people as a result.
The historic progress made in prescribing antibiotics was also reversed during the pandemic. Antibiotics were often the first choice given to treat those who had symptoms similar to fever pneumonia and difficulty breathing, although it often represented the viral disease of COVID-19, for which antibiotics are not effective. From March 2020 to October 2020, nearly 80% of patients hospitalized with COVID-19 received an antibiotic. While some of these prescriptions may be appropriate when the risks of related bacterial or fungal infections are unknown, this high level of prescription may also put patients at risk for side effects and create a pathway to develop and spread resistance. .
Despite the pandemic, by 2020, more than 90% of U.S. hospitals had an antibiotic management program aligned with the basics of CDC hospital antibiotic management; which may have contributed to the reduction of Clostridioides difficile infections.
During the pandemic, many antimicrobial resistance programs helped stop the spread of COVID-19. For example, CDC’s AR Solutions Initiative provided experience in infection control in health facilities, many of them in nursing homes, to conduct more than 14,000 outbreak consultations; CDC’s AR Lab network sequenced more than 4,700 SAR-CoV-2 genomes; and the CDC NHSN, which promotes patient safety programs by monitoring antimicrobial-resistant infections and the use of antibiotics in health care, provided additional capabilities to support COVID data collection -19 in hospitals and nursing homes.
“We need to emphasize and expand the implementation of effective prevention strategies that are already in the CDC toolbox in all health centers,” said Denise Cardo, MD, director of the Quality Promotion Division CDC Sanitary. “The 2021 launch of the Global AR Lab and Response Network and the Global Action in Healthcare Network is an example of how the CDC is aggressively moving to combat antimicrobial resistance not only in the United States but in almost “50 countries around the world. We have made significant progress. Before the pandemic, and I am sure we will make significant progress in the future.”
With prevention and preparedness as the primary goal, the CDC remains committed to the U.S. National Action Plan to Combat Antibiotic-Resistant Bacteria (CARB) and will move forward by addressing gaps in the public health system and exploring investments in US healthcare infrastructure in the following key. areas:
- Improve and share data systems: Expand automation of electronic data under NHSN to enable healthcare facilities and systems to have the information they need about antibiotic use and antimicrobial resistance. In addition, this includes sharing established networks such as CDC’s network of AR laboratories during emergencies, using telehealth for contact tracking, and working to support uninterrupted laboratory supplies and equipment for patient care and control. of infections.
- Infection Control: Continue to provide high-quality infection prevention and control training such as Project Firstline to all health professionals and health centers beyond hospitals, such as nursing homes and other care centers long-term. This also means educating the public on how to stop the spread of germs and practicing infection prevention in the communities where they live and work.
- Use and access of antibiotics / antifungals: optimization of antibiotic use in all healthcare settings and implementation of CDC basics in all healthcare settings. In addition, working to promote the optimal use of antibiotics and antifungals and the monitoring of pets and agriculture.
- Environment and sanitation: expansion of the capacity of the National Wastewater Monitoring System to collect data on antimicrobial resistance of wastewater treatment plants and sanitation facilities, studying the resistance to community and sanitary wastewater at the level national and global. This also includes expanding global capabilities to combat antimicrobial resistance in the environment and controlling antimicrobial resistance at One Health.
- Vaccines, therapeutics and diagnosis: improving inter-agency collaboration to accelerate research to develop new antibiotics, antifungals and therapeutics. For example, working with the Food and Drug Administration to identify ways to support the availability of decolonization products. This also includes supporting the use of vaccines to prevent infections, slowing the spread of resistance and reducing the use of antibiotics, and creating a vaccine data platform to inform the development of new vaccines.
CDC is and will continue to be at the forefront of the fight against antimicrobial resistance. While the pandemic reversed much of the progress of the past decade in infection prevention and control, the fight will now have a renewed fervor in prevention-focused public health actions to keep the nation safe.
Source:
Centers for Disease Control and Prevention