A surprising consequence of the COVID-19 pandemic has been a surge of infections caused by superbugs – microorganisms that are resistant to antibiotics and antifungal treatments and often spread in hospitals.
Hospital-onset infections and deaths caused by superbugs each increased by at least 15% in 2020, the first year of the pandemic, a new report from the U.S. Centers for Disease Control and Prevention shows.
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More than 29,400 people died from superbug infections commonly associated with health care, the CDC found. Forty percent of these people acquired the infection while in the hospital. Because of data gaps, the total number of deaths caused by superbugs was most likely even higher.
Infections caused by two particular types of bacteria that have grown resistant to medicine jumped significantly.
Acinetobacter infections, increased by 78%, and pseudomonas aeruginosa infections rose by 32%. They are both gram negative bacteria, which have an outer membrane that protects them from many antibiotics. Hospital patients on ventilators, catheters and those with wounds from surgery or burns are among those at highest risk of these infections.
The fungal disease Candida auris rose by 60%. It's a type of yeast that can enter the bloodstream, causing severe infections. Patients who have been hospitalized for a lengthy period of time, or have a catheter or other type of tubing entering their bodies are most at risk.
There was also a 13% increase in MRSA infections. The staphylococcus aureus bacteria, which can be found on people's skin, mostly causes skin infections. But in hospital settings, it also can cause bloodstream infections, pneumonia or surgical site infections, potentially leading to sepsis or death.
The CDC said delayed or unavailable data during the pandemic led to resistant infections spreading undetected and untreated. The report also found large increases in antibiotic use, and a difficulty following infection prevention and control guidance – necessary to combat the spread of superbugs – in U.S. hospitals in 2020.
Challenges with personal protective equipment, staffing shortages and longer patient stays all played a role in the increase of superbug infections that occurred during hospitalization, the report said. So did the fact that many patients required more frequent and longer use of medical devices, like catheters and ventilators.
"This setback can and must be temporary," said Michael Criag, director of the CDC's Antibiotic Resistance Coordination and Strategy unit. "The COVID-19 pandemic has unmistakably shown us that antimicrobial resistance will not stop if we let down our guard; there is no time to waste. The best way to avert a pandemic caused by an antimicrobial-resistant pathogen is to identify gaps and invest in prevention to keep our nation safe."
The report's findings were in stark contrast to a 2019 report that showed superbug infections dropped by 27% between 2012 and 2017. The only hospital-related pathogen to decline in 2020 was Clostridiodes difficule, a type of bacteria that infects the large intestine.
In the 2019 report, the CDC estimated at least 2.8 million antimicrobial-resistant infections occur in the U.S. each year, with more than 35,000 people dying.
Progress on overprescribing antibiotics also has been reversed, the CDC found. In the early days of the pandemic, when there was little information available about COVID-19, patients who presented with pneumonia-like symptoms often were treated with antibiotics first.
COVID-19 is a viral infection for which antibiotics are not effective. Between March 2020 and October 2020, almost 80% of patients hospitalized with COVID-19 received an antibiotic.
"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 CDC report says.
The CDC said it will continue to address gaps in the public health system by enhancing data sharing, promoting optimal optimal antibiotic and antifungal use, expanding the capacity of the National Wastewater Surveillance System to collect antimicrobial resistance data from wastewater treatment plants and health care facilities, and support the development of new treatments and diagnostic tools.
"We need to emphasize and expand the implementation of the effective prevention strategies that are already in CDC's toolbox to all health care facilities," said Dr. Denise Cardo, director of the CDC's Division of Healthcare Quality Promotion.