The pandemic “pushed back years of progress” in the fight against deadly superbugs as hospital-acquired infections and deaths rose considerably in 2020, the U.S. Centers for Disease Control & Prevention said in a report this week.
Nearly 30,000 people died from superbugs — a bacteria, virus, parasite or fungus resistant to antimicrobial drugs — most associated with health care settings. Two out of every five people who died in 2020 acquired the infection in a hospital, a 15% increase from 2019.
“COVID-19 created a perfect storm,” the report said.
There were sicker patients who were hospitalized for longer periods compared to before the pandemic, which left patients especially vulnerable to infections associated with long hospital stays.
About 80% of patients hospitalized with COVID-19 received antibiotics.
“While some of this prescribing can be appropriate when risks for related bacterial or fungal infections are unknown, this high level of prescribing can also put patients at risk for side effects and create a pathway for resistance to develop and spread,” the report said.
The risk of contracting a bacterial or fungal infection typically increases the longer someone stays in a hospital.
The longer someone is on a ventilator or a catheter, for example, or is getting their blood drawn often means that there is “more access to the closed off spaces in your body than normal,” where bacteria and fungus can slip in, Dr. Lori D. Banks, an assistant professor of biology at Bates College in Lewiston, said.
“It’s a twofold thing where it’s got new access that it didn’t have before and your immune system is not strong enough to fight it off,” Banks said.
And it is common that patients with viral respiratory tract infections to develop a co-occurring bacterial infection, Central Maine Medical Center pharmacist Heather Bowman said. Bowman also co-leads the hospital’s antimicrobial stewardship program with Dr. Imad Durra.
“At the outset of COVID-19, the prevalence and incidence of bacterial co-infections was not known and given the high mortality seen in the beginning of the pandemic, there was a more liberal use of antibiotics seen nationally,” Bowman said.
“We now have better data to support that bacterial co-infection is less common than initially thought and have better treatments, such as the antiviral Paxlovid, to treat COVID-19,” she said.
Overprescribing of any antimicrobial — in this case, antibiotics — can inadvertently weed out the superbugs from among the pack, Banks said.
Microbes like viruses and bacteria are constantly replicating themselves and unlike humans, whose cells completely regenerate on the order of every 25 to 30 years, these microbes are replicating in a matter of minutes or hours.
Every time one of them replicates, there’s room for error. That error is a mutation, some of which are resistant to antimicrobial treatments. In the case of antibiotic resistance, for example, Banks said the bacteria “make these sort of PacMan-looking enzymes that are able to literally like chew on the drug and make it ineffective,” Banks said.
There may only be a couple microbes with these mutations out of a few million or billion, but what the antimicrobe will do is kill all the mutation-less microbes and single out the superbugs.
“You’re selecting for or enriching the environment to allow for their survival,” Banks said. “And so that’s what we see is that in these repeat exposures to antibiotics we’re actually creating the population that’s dangerous.”
But with nearly 80% of COVID-19 patients on an antibiotic, this process is repeated on a massive scale, Banks said.
Staffing and supply shortages nationwide may have also contributed to lapses in infection control and prevention in hospitals.
“When anyone is asked to work harder and longer hours with less support, fatigue develops, shortcuts may be created and it can result in adverse events, such as ultimately the spread of antibiotic-resistant bacteria,” Joanne Kenny-Lynch, CMH’s system director of infection prevention, said.
While all three hospitals in CMH’s network — CMMC, Bridgton Hospital and Rumford Hospital — did not have any documented or notable increases in antimicrobial-resistant infections, Maine saw some increases statewide.
According to the Maine CDC’s annual infectious disease report, there was a 14% increase in Methicillin-resistant Staphylococcus aureus, or MRSA, infections in 2020 compared to 2019. The U.S. CDC report identified MRSA as a “serious” public health threat.
While superbugs are a very real and present danger made worse by the pandemic, there are a few easy ways to combat these infections, Banks said.
First: Throw out that antibacterial hand soap. Or hand lotion. Or all-purpose cleaner. Antibacterial products and antibiotics attack all cells the same, whether it is the “good” kind or the “bad” kind.
“And so if we are trying to kill off the bad guys but also killing off the good guys, that’s not helpful or healthy,” she said. Outside of clinical settings, Banks said to avoid antibacterial products.
Second, while people like Kenny-Lynch and Bowman at CMMC are working directly with prescribers to avoid prescribing antibiotics when they are unnecessary, Banks said it is always helpful to have a discussion with your provider before they prescribe antibiotics to decide if that is the best course of action.
The Maine CDC is surveying Mainers on their knowledge of antibiotics and their questions for an educational program that will run in November during U.S. Antibiotic Awareness Week. To participate, visit https://forms.office.com/g/usvUZF8xZh.
This story was updated to include information about the Maine CDC survey.
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