The desperate need to save the lives of Covid patients during the pandemic’s first waves, coupled with shortages of hospital personnel and protective equipment, drove a shocking reversal in progress against deadly superbugs, according to a new analysis by the US Centers for Disease Control and Prevention.
The report, released July 12, synthesizes lab and hospital-admission data to reach a grim conclusion: From 2019 through 2020, the number of antibiotic-resistant infections occurring in hospitals, and resulting deaths, each increased by at least 15 percent. For some of the most hard-to-treat pathogens, the increases shot up from 26 percent to 78 percent. And those figures are even worse than they appear, because in the years immediately preceding the pandemic, resistant infections in hospitals across the US had been forced down by almost a third—meaning that Covid wiped out years of progress in reducing one of health care’s most stubborn threats to patients.
“The pandemic created the perfect storm for this to happen,” says Arjun Srinivasan, a physician and associate director of the CDC’s health-care-associated infection-prevention programs. “You had large numbers of patients needing very advanced care, often in intensive care units—needing central lines, needing urinary catheters, needing mechanical ventilation; all of those increasing risks for infection, all of those increasing risks for infections with antibiotic-resistant organisms.”
But medical experts say that hidden within the dismaying trend—and this isn’t present in the CDC’s report—is a surprising bright spot. Some US hospitals managed to reduce their patients’ vulnerability to superbugs because they kept supporting prevention programs they had set in motion before the pandemic started, and especially because they kept those programs’ personnel from being diverted to different tasks.
Any use of an antibiotic carries the possibility of provoking resistance, because bacteria adapt to defend themselves. So hospitals run programs, broadly known as antibiotic stewardship, that monitor which drugs are being used and reserve the most precious compounds as last-report options. Simultaneously, they maintain infection-prevention teams to protect patients against infections that can arise when medical devices accidentally conduct bacteria inside the body, or drug treatments suppress the immune system, or pathogens are carried between patients on staffers’ gowns or hands.
When masks and protective equipment ran short during the first waves, health care workers could not swap out their gear as they normally would have. In deluged wards, they may have skipped safety steps to try to save lives. And as desperately ill patients overwhelmed ICUs, clinicians preemptively put them on antibiotics—not to control Covid, because the virus isn’t affected by these drugs, but to ward off other infections. The CDC analysis finds that in 2020 almost 80 percent of Covid patients received at least one antibiotic during their hospital stay, a far higher percentage than normal.
Uneasy predictions during the past two years suggested this might happen. In the first months of the pandemic, multiple experts, including a former CDC director, published warnings that broad use of antibiotics among the earliest Covid patients was lighting the fuse on a time bomb. In March 2021, a project of the Pew Charitable Trusts predicted that resistance rates were sure to rise, because so many Covid patients were receiving antibiotics. And by the end of that year, evidence began to arrive that they were right. A CDC analysis last September revealed that Covid’s pressures on health care reversed years of progress in reducing infections in already-hospitalized people. This May, researchers from pharmaceutical giant Merck and medical-technology company Becton Dickinson presented preliminary data showing that rates of resistant infections in 271 US hospitals rose in 2020 and 2021—in patients with and without Covid—compared to 2019.