The report analyzed antimicrobial resistance in the United States, focusing specifically on superbug infections that started in hospitals.
Public health efforts had driven down these resistant infections in hospitals by nearly 30 percent between 2012 and 2017. But in 2020, the pandemic pushed hospitals, health departments and communities “near their breaking points,” CDC Director Rochelle Walensky wrote in the report.
Sicker patients overwhelmed hospitals. They needed more frequent and longer use of medical devices, such as catheters and ventilators. Devices that break the body’s natural protective barrier — the skin — increase infection risk.
Clinicians unfamiliar with the new covid-19 disease relied heavily on antibiotics as the first option to treat patients with fever and shortness of breath — symptoms of the viral illness. From March 2020 to October 2020, almost 80 percent of patients hospitalized with covid-19 received an antibiotic, the report said. Those lifesaving drugs work against bacteria, not against viruses. High levels of antibiotic prescribing can put patients at risk for side effects and allow drug-resistance to develop and spread.
In addition, hospitals faced severe shortages of staff and personal protective equipment, especially the higher-quality N95 masks that offer the best protection. In some places, hospital personnel used parts purchased from Home Depot and craft stores to create protective face shields for workers. Overwhelmed staff had difficulty following infection prevention and control protocols, the report said. Many personnel were pulled away from infection control to help take care of patients with covid-19. That created a kind of double whammy: fewer staff members to prevent infections treating more patients at risk for them.
“In addition to having devastating impacts for the millions of people who got covid and the millions of people who died of covid, the covid pandemic had a profound and far-reaching impact on the safety of patients in the United States,” said Arjun Srinivasan, the top CDC official leading the agency’s prevention efforts to control superbugs. “One of the knock-on effects of covid … is with these antibiotic-resistant infections, infections that are very difficult to treat, in some cases untreatable, with very high rates of mortality.”
Some patients recovered from their covid-19 illness, he said, only to face “a horrible outcome”: dying from a drug-resistant infection.
In 2020, more than 29,400 people died of antimicrobial-resistant infections commonly associated with health care, the report found. Of these, nearly 40 percent acquired the infection while hospitalized. The remaining infections occurred outside the hospital, including in nursing homes and other community health-care facilities. Because of limited data, the CDC does not know how many people who died of superbug infections also had covid-19.
The CDC estimates more than 2.8 million antimicrobial-resistant infections in the United States each year, with more than 35,000 people dying as a result. The total number of deaths in 2020 from these resistant infections may be much higher; surveillance and data reporting were curtailed because of the pandemic.
Antimicrobial resistance occurs because bacteria are constantly evolving to fend off the drugs used to kill them. As they mutate, some bacteria develop the ability to fight off different antibiotics, multiplying and spreading resistance along the way. The more antibiotics are used in health care and agriculture, the less effective they become.
Antibiotic resistance is particularly deadly for patients in hospitals and nursing homes, and those with weak immune systems. But these hard-to-treat infections now threaten people undergoing common modern surgeries and therapies, such as knee replacements, organ transplants and cancer treatments.
Young and otherwise healthy people can get a methicillin-resistant Staphylococcus aureus, or MRSA, infection on their skin. Women can get a urinary tract infection from another bad bug, ESBL-producing enterobacteriaceae, that can no longer be treated with first-line oral medications and require intravenous antibiotics.
Hospital infections rose in the first year of the pandemic for three of the five resistant bacteria and fungi that pose the greatest threats to human health. The biggest jump was in carbapenem-resistant Acinetobacter, bacteria that cause pneumonia and wound, bloodstream, and urinary tract infections, often among patients in intensive care units. In 2020, hospital infections for carbapenem-resistant Acinetobacter jumped 78 percent, with 7,500 cases and 700 deaths, the report found.
There was also a 60 percent increase in hospital infections of a deadly superbug yeast called Candida auris, and a 35 percent increase in hospital infections of carbapenem-resistant enterobacteriaceae (CRE), also known as “nightmare bacteria.” CRE are a large group of bacteria of major concern for patients who require catheters and other devices, long courses of some antibiotics or long hospital stays. The superbugs are resistant to all or nearly all antibiotics, kill up to half of patients who contract bloodstream infections, and can transfer their antibiotic resistance to other related bacteria, potentially making the other bacteria untreatable.
The CDC had previously categorized the toll that 18 pathogens are taking on humans, ranking the threat of each as “urgent,” “serious” or “concerning.” But the agency is missing data for nine of those germs, including many that are spread outside hospital settings. They include sexually transmitted drug-resistant gonorrhea and drug-resistant Streptococcus pneumoniae, a leading cause of bacterial pneumonia and meningitis.
Of the roughly 6,000 U.S. hospitals, about 2,400 voluntarily submit monthly data on antibiotic use to the CDC, Srinivasan said; of those, about 1,100 are also providing data about resistant bugs.
“We don’t have the data because our surveillance systems weren’t able to even function to provide us that information during the pandemic,” Srinivasan said. “That should be every bit as alarming to people as the pathogens that went up. It’s just as alarming when you don’t know.”