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Covid set back progress on combating drug-resistant ‘superbugs’

Deaths from bacteria resistant to antibiotics were dropping prior to the pandemic, but Covid-19’s impact on hospitals and government data collection created new challenges in preventing their spread.

ATLANTA (CN) — The Centers for Disease Control and Prevention released a special report Tuesday detailing Covid-19's impact on antimicrobial resistance, which occurs when germs like bacteria and fungi defeat the drugs designed to kill them.

Infections from so-called "superbugs" are a leading cause of death globally, with the highest impact in low-resource countries.

According to a 2019 CDC report on antibiotic resistance threats, "prevention is the most foundational and successful tool" to protect people from superbug infections. The emergence of Covid-19 only amplified the need to improve infection preventive efforts in the U.S.

Between 2012 and 2017, deaths from antimicrobial resistance decreased by 18% overall and nearly 30% in hospitals, but the pandemic caused setbacks in this progress.

Superbug infections are amplified in health care settings as germs spread among patients and across facilities. As hospitals saw higher numbers of sicker patients who needed extended lengths of stay, on top of staffing and equipment shortages, these hospital-associated infections increased by 15% from 2019 to 2020.

Hospitals reported increased outbreaks of Acinetobacter and Enterobacterales bacteria, both of which can cause severe illness in hospitalized patients and are resistant to nearly all antibiotics.

Also, after years of decreasing cases, antifungal-resistant Candida infections increased in 2020. The bacteria can become life-threatening if it infects the bloodstream.

According to the CDC, the increase in superbug infections underscores the significant role these difficult-to-treat pathogens play in hospital infections and the need to contain further spread.

When Covid-19 cases increased in hospitals, so did antibiotic use, creating another obstacle in the CDC's tracking and prevention of antimicrobial resistance.

While antibiotics and antifungals can save lives when administered correctly, they are often prescribed by health care workers for emerging infectious diseases when no other treatments options are known or available.

Not only does this put patients at risk for side effects, but it further contributes to the development and spread of resistance.

"Vaccines can significantly reduce infection rates, which decreases antibiotic use and the number of resistant germs. For example, drug-resistant S. pneumoniae is one of the only germs listed in this report with effective vaccines to prevent infections, including pneumococcal conjugate vaccines (PCVs)," the CDC report states.

According to the report, the PCV13 vaccine protects people from 13 types of pneumococcus, including resistant forms, and prevented more than 30,000 cases of invasive pneumococcal disease and 3,000 deaths from 2010 to 2013 alone.

Many bacterial and fungal infections also went potentially undiagnosed and untreated during the pandemic, as many outpatient clinics closed or limited appointments, resulting in fewer in-person visits.

This is what the CDC said caused the drug-resistant tuberculosis, which develops from the misuse of TB antibiotics, to decline 28% from 2019 to 2020.

Impacts of the pandemic caused much of the CDC's 2020 data on antimicrobial resistance threats to be delayed or unavailable, such as for drug-resistant Streptococcus pneumoniae, a leading cause of bacterial pneumonia and meningitis in the U.S., and Group A Streptococcus (GAS), the most common bacterial cause of strep throat.

Data is also not yet available for the number of drug-resistant gonorrhea infections in 2020, which have drastically increased in recent years as the bacteria rapidly develops resistance to antibiotics.

However, cases of some drug-resistant illnesses such as salmonella, typhi, Campylobacter and Shigella that spread through contaminated food and water dropped in 2020. According to the CDC, the decrease could be attributed to pandemic behaviors, such as limited international travel, fewer restaurant meals, closed schools and daycares, fewer emergency department visits for abdominal symptoms, and increased telehealth visits that may have reduced stool sample collection.

"The United States must continue to invest in prevention-focused public health actions, such as accurate laboratory detection, rapid response and containment, effective infection prevention and control, and expansion of innovative strategies to combat antimicrobial resistance. If properly resourced, the United States can continue to build resilient domestic and global public health systems to keep our nation safe against the threats of antimicrobial-resistant pathogens," the report states.

Since 2016, the CDC has invested more than $160 million in research to address superbug knowledge gaps with solutions such as vaccines, therapeutics, diagnostics and other prevention tools.

Efforts to identify antimicrobial-resistant germs, track the spread of resistance, and measure the effect of antibiotic or antifungal use require a "One Health" approach to surveillance, according to the CDC, in that the problem impacts not just human health, but animals, plants and the environment as well.

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