CDC: Pandemic onset reversed gains on drug-resistant infections caught in hospitals

The onset of the COVID-19 pandemic accompanied an “alarming increase” in drug-resistant infections that are spread in hospitals, the Centers for Disease Control and Prevention (CDC) shared in a new report.

Following a recorded 30% decline in deaths from hospital-acquired antimicrobial-resistant infections, the public health agency’s data indicated “at least” a 15% increase in both cases and deaths attributed to resistant infections that began in hospitals from 2019 to 2020.

Writing in the report (PDF), CDC Director Rochelle Walensky, M.D., attributed the jump to a “significant increase in antimicrobial use [and] difficulty in following infection prevention and control guidance” during the early days of the pandemic.

Previous years’ “historic gains” in antibiotic stewardship were thrown out the window when clinicians initially turned to antibiotics when treating COVID-19 symptoms, Walensky wrote. Almost 80% of patients who were hospitalized with COVID-19 between March and October received an antibiotic, according to the report.

Further increasing the risk for healthcare-associated, antimicrobial-resistant infections were sicker patients who required longer stays and more frequent use of devices such as catheters and ventilators where several of these infections thrive, the CDC wrote. Hospitals also struggled to maintain infection control due to personal protective equipment supply issues and staffing shortages, the CDC said.

Public health’s resources for monitoring these antimicrobial resistance incidents were forced to shift to COVID-19 tracking “in some instances,” according to the report. This, alongside other data collection road bumps, forced the CDC to postpone numbers for nine antimicrobial-resistant infections that would have been included in this week’s report, such as Clostridioides difficile.

Among the hospital-acquired infections on which the CDC could report, the agency saw year-over-year increases ranging from 78% (carbapenem-resistant Acinetobacter) to 13% (methicillin-resistant Staphylococcus aureus). Antifungal-resistant diseases were also on the rise, with Candida auris increasing 60% overall from 2019 to 2020, according to the agency.

“The COVID-19 pandemic has unmistakably shown us that antimicrobial resistance will not stop if we let down our guard; there is no time to waste,” said Michael Craig, director of CDC’s Antibiotic Resistance Coordination and Strategy Unit, in a statement. “The best way to avert a pandemic caused by an antimicrobial-resistant pathogen is to identify gaps and invest in prevention to keep our nation safe.”

In an accompanying release, the CDC said it knew of 29,400 people who died from antimicrobial-resistant infections during 2020, almost 40% of whom were infected while they were in the hospital.

Although lower than the 35,000 death estimate for 2019, the CDC warned the total number of 2020 deaths “may be much higher” due to the year’s incomplete data collection.

Alongside encouraging all healthcare settings to remain focused on infection control and cutting down ineffective antibiotic and antifungal use, the agency called for greater investment in data collection infrastructure, wastewater surveillance and research into new treatments.