The pandemic has made antibiotics less effective

Prior to the COVID-19 pandemic, experts warned of an antibiotic resistance crisis due to overuse of antibiotics in treating infections and in agriculture.

The pandemic has worsened the crisis, causing an increase in antibiotic-resistant “superbug” infections and deaths in hospitals, according to a report from the Centers for Disease Control and Prevention (CDC).

In 2020, infections and deaths from antimicrobial resistant bacteria both increased by at least 15% compared to 2019. A particular type of bacteria called carbapenem resistant Acinetobacter—which can cause infections of the blood, urinary tract, lungs and wounds, drastic increase of 78% in one year.

David Hyun, MDDirector of the Antibiotic Resistance Project at the Pew Charitable Trustssaid that when bacteria, viruses and fungi are resistant to antibiotics, it is much more difficult to treat infections.

“Antibiotic resistance occurs when bacteria are exposed to different antibiotics, and this exposure provides an opportunity for bacteria to learn and essentially evolve to become resistant to survive,” Hyun said. “This is how bacterial resistance can move from one type of bacteria to another. It is a very serious situation. »

If the bacteria become resistant to the antibiotic, they can spread from person to person and become more prevalent in the community.

For example, gonorrhea, a sexually transmitted infection, has become increasingly resistant over the past two decades. From 2017 to 2019, there was an increase in gonorrhea infections with resistance to one of the six antibiotics currently recommended to treat it, according to the CDC.

“We’re basically at an antibiotic that can reliably treat gonorrhea infections,” Hyun said. If left undetected or untreated, the disease can lead to serious health complications and continue to circulate in a community, increasing the chances that it will develop resistance to available treatments and potentially others.

Why are we seeing more antibiotic resistance now?

At the start of the pandemic, many hospitalized COVID-19 patients were prescribed antibiotics because little was known about the ideal treatment for the virus, Hyun said. From March to October 2020, nearly 80% of patients hospitalized with COVID-19 received an antibiotic, although studies have found only a small portion of these patients had bacterial infections.

“The more antibiotics are used, the higher the risk of emergence and development of antibiotic resistance,” Hyun said. “The more potent antibiotics are used in the hospital, the more likely resistant bacteria will emerge from these environments as well.”

Additionally, hospitalized COVID-19 patients had much longer stays compared to a typical patient who was admitted to hospital for something else. Patients with COVID-19 also used medical equipment or invasive therapies, such as catheters and ventilators, more frequently and for longer, which may increase the risk of infections and the spread of pathogens, said Hyun.

When combined with shortages of personnel, supplies and personal protective equipment, the risk of infection also increases.

But the increased habit of hand washing and sanitizing probably did not contribute to antimicrobial resistance, Hyun noted. “Hand sanitizer, Clorox wipes and the like aren’t antibiotics per se, because those things are a different mechanism,” he said.

Even before the pandemic, there was a long-term problem with overprescribing antibiotics in situations where they may not have been needed, according to Neera Ahuja, MDClinical Professor of Medicine at Stanford Hospital and Clinics.

Additionally, the rise of telemedicine has limited the physical examination of patients, potentially prompting a “play it safe” approach where a provider will prescribe an antibiotic for what could be a viral illness, Ahuja explained.

Who is most at risk of antibiotic resistant infections?

According to the CDC report, more than 29,400 people died from antimicrobial-resistant infections in healthcare facilities in 2020. Nearly 40% were infected while hospitalized, and the remaining infections occurred in nursing homes. and other community health care facilities.

Hyun said immunocompromised people are most at risk of developing antibiotic-resistant infections and having poorer health outcomes. Newborn babies are also at risk because they do not have a fully developed immune system. Those with chronic illnesses who cannot fight or prevent infections may also be at risk.

While perfectly healthy people aren’t thought to be most at risk of contracting antibiotic-resistant infections, Hyun added, they aren’t completely left out as these infections “start to creep into communities,” beyond health care institutions. .

How can we solve this crisis?

One of the ways to combat antibacterial resistance is to educate both the public and healthcare professionals.

It is important to continue and develop antimicrobial stewardship programs in hospitals, which help healthcare professionals choose the best antibiotic for a patient to treat any bacterial infection and reduce unnecessary medication use, Javeed Siddiqui, MD, MPHco-founder and medical director of TeleMed2UVerywell said in an email.

Siddiqui said these programs should also be implemented in community health care settings, including doctors’ offices, urgent care centers, nursing homes and specialty outpatient services like dentistry or pain management clinics.

In addition to reducing the use of antibiotics, Hyun suggested that more resources and research are needed to create new antibiotics.

Finally, everyone has an important role to play in the use of antibiotics. Patients who see a doctor when they are sick should keep an open mind and understand how antibiotics are used and when they are needed or not.

“We strongly encourage patients when seeing doctors to have an open conversation about the risks and benefits of antibiotics and to ask questions about their condition and whether they really need it,” Hyun said. “This is probably one of the most important roles patients can play in terms of reducing the inappropriate use of antibiotics.”