Hospitals are grappling with deadly super bugs
Key Takeaways
The rate of superbugs caused by antimicrobial resistance (AMR) increased during the COVID-19 pandemic, in part due to the overuse of antibiotics, according to US and global data.
Hospital-based infections remain above pre-pandemic levels in US hospitals, with the greatest increase in carbapenem-resistant Acinetobacter baumannii (CRAB).
The correct use of antibiotics often outweighs the risks associated with side effects of AMR and can avert many deaths from bacterial infections.
The rate of superbugs—bacterial infections that do not respond to treatment with antibiotics—increased during the COVID-19 pandemic, partly due to the excessive use of antibiotics. This rate remains above pre-pandemic levels in US hospitals, according to results from two studies by the World Health Organization (WHO) and the National Institutes of Health (NIH), presented at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global 2024.[]
“While overall antimicrobial resistance levels appear to have almost returned to pre-pandemic levels, the persistence of high rates of hospital-acquired AMR infections in US healthcare facilities is concerning,”Christina Yek, MD, lead author of the NIH study, stated in a press release. “More action is needed to protect people, especially from difficult-to-treat hospital-acquired gram-negative infections that remain concerningly high.”[]
Antibiotic overuse
The WHO investigators gathered data from around 450,000 people in 65 countries between January 2020 and March 2023. They found that around 8% of patients hospitalized with COVID-19 also had a bacterial infection that required antibiotics.[]
However, 75% of patients without a bacterial infection received antibiotic treatment as a precaution. Among patients with severe or critical COVID-19, 81% received antibiotic treatment. The investigators found that antibiotic use potentially led to poorer outcomes for patients with COVID-19 and no bacterial infection.
“When a patient requires antibiotics, the benefits often outweigh the risks associated with side effects or antibiotic resistance. However, when they are unnecessary, they offer no benefit while posing risks, and their use contributes to the emergence and spread of antimicrobial resistance,” said WHO study author Silvia Bertagnolio in a press release. “These data call for improvements in the rational use of antibiotics to minimize unnecessary negative consequences for patients.”
US hospitals at risk
They included data from 120 hospitals from January 2018 to December 2022, during which they examined all adult hospitalizations for infection by six pathogens: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum cephalosporin-resistant Enterobacterales (ECR), carbapenem-resistant Enterobacterales (CRE), CRAB, and carbapenem-resistant Pseudomonas aeruginosa (CR-PA).[]
During the COVID-19 pandemic, the rate of AMR infections increased by 6.3%, with hospital-acquired infections (occurring after 3 days of hospitalization) up 32% and community-acquired infections (occurring before hospitalization) up 1.4%. The greatest AMR infection increase occurred in hospital-acquired infections resistant to carbapenems, antibiotics used as a last resort when treating severe infections. These included a 151% increase in CRAB during the pandemic, a 62% increase in CRE, and a 54% increase in CR-PA. Meanwhile, during and after the pandemic, community-acquired MRSA infections declined by 10% and 19%, respectively.
Interestingly, while the WHO study found the highest antibiotic use among patients with severe COVID-19, the NIH study found that hospitals with the greatest surges in severely ill COVID-19 patients experienced the largest increases in hospital-acquired AMR infections. Dr. Yek explained that “[i]t is likely that surges in severely ill COVID-19 patients during the pandemic corresponded with significant surges in antibiotic use and challenges following infection and prevention control protocols in strained hospitals.” She added that the AMR spread may have been exacerbated by “shortages of personal protective equipment while treating sicker patients who were more likely to require the use of medical devices like ventilators.”
As of December 2022, hospital-acquired AMR infections were 13% above pre-pandemic levels, mainly due to gram-negative infections that are resistant to commonly prescribed first-line antibiotics. Hospital-acquired carbapenem-resistant infections remained at least 35% higher than pre-pandemic levels.
Superbug prevention
A new series of papers published in The Lancet links nearly 5 million deaths around the world each year to AMR infections. The series highlights the need for all patients to have access to affordable, effective antibiotics and outlines actions for infection prevention and control, including the use of diagnostic tests to guide treatment. The authors recommend using vaccines to prevent AMR infections and other pathogens that increase the demand for antibiotics, such as viruses that result in secondary bacterial infections.[]
“Antibiotics, if used as indicated, can avert many deaths from bacterial infections, and access to second-line antibiotics can even prevent deaths from some drug resistant infections,” The Lancet authors wrote.
What this means for you
AMR infections have largely returned to pre-pandemic levels, but hospital-acquired infections remain high, linked to the overprescription of unnecessary antibiotics. Making an accurate diagnosis will help guide antibiotic use. This correct use often outweighs the risks associated with side effects or AMR.