A bright spot in public health, before the pandemic, was the progress that hospitals had made against antibiotic resistance, the tendency of bacteria and other pathogens to evolve so they fight or evade lifesaving drugs. But the crushing burden of the pandemic has undone this progress. It can and must be regained.
Superbugs are rising again. Hospitals must regain the edge.
Antibiotic resistance is a global public health crisis, a shadow pandemic. It threatens the effectiveness of medicines that are vital for surgery, chemotherapy, organ transplants and other procedures. It has been known for decades that bacteria evolve to resist antibiotics, and that overuse in human health and animal agriculture have contributed to the worsening situation. Some bacteria have become “superbugs” resistant to several types of antibiotics.
A 2019 report by the Centers for Disease Control and Prevention found that deaths because of antimicrobial resistance in the United States had dropped 18 percent overall during the previous seven years, and nearly 30 percent in hospitals, thanks to improved infection control and antibiotic stewardship.
Now comes a new CDC report with the sober warning that antibiotic resistance is on the rise again where it had previously slowed.
Why? When the pandemic hit, the virus wasn’t fully understood, and many patients who suffered respiratory ailments were given antibiotics. From March to October 2020, almost 80 percent of patients hospitalized with covid-19 received an antibiotic. It was not effective against a virus, but the damage had been done by using antibiotics so often. According to the CDC report, resistant hospital-onset infections and deaths both increased at least 15 percent in the first year of the pandemic. After a long period of reductions in health-care-associated infections, known as HAIs, U.S. hospitals saw significantly higher rates for four out of six types of HAIs in 2020, many of them resistant to antibiotics.
More and sicker patients during the pandemic required more frequent and longer use of catheters and ventilators, spreading pathogens and increasing risk. On top of that, many hospitals suffered shortages of personal protective equipment, critical to controlling infections, as well as pressure on laboratory work and staffing, and resources were stretched thin. The pandemic also delayed or canceled treatment for people with other illnesses, which might have helped antibiotic resistance to expand. According to the CDC, U.S. health-care facilities reported many outbreaks of Acinetobacter bacteria resistant to antibiotics. The infection often occurs in intensive care units and is common with respiratory ailments. Hospital-onset infections of Acinetobacter resistant to carbapenems, a class of effective antibiotics, jumped 78 percent in 2020 compared with the year before. Yet another setback was that the pandemic delayed collecting data about antibiotic resistance.
Importantly, the progress made in earlier years can be renewed. Hospitals have much better procedures to employ good stewardship of antibiotics than a decade ago. Rapid diagnostics for covid will help avert misuse of antibiotics. It is critical to distribute antibiotics judiciously, treating them as a valuable resource for all. Fighting antibiotic resistance is a long-term challenge, and the pandemic should not be allowed to reverse the progress that has been made — and can be made again.
Source: WP
