By Kalvin Yu, MD, FIDSA, Vice President of U.S. Medical Affairs and Vikas Gupta, Pharm.D., Director of Medical Affairs

In August, we provided data showing that the COVID-19 pandemic has undone progress on antimicrobial resistance (AMR). This data, which expanded on the U.S. Center for Disease Control and Prevention’s (CDC) report, “COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022,” showed that the pandemic forced public health resources to shift from tracking AMR to the constant surveillance of COVID-19 caseloads. Ultimately, this shift led to notable increases in infections across hospital-onset pathogens – as hospital-onset infections and deaths both increased at least 15 percent during the first year of the pandemic¹.

We continue to echo the CDC’s recent sentiment that “these setbacks can and must be temporary.” The COVID-19 pandemic has made it clear that prevention is preparedness. As healthcare leaders across the globe honor and recognize World Antimicrobial Awareness Week, we wanted to share recently-published data that further underscores the need for continued  attention to AMR stewardship.

Here's what our data show:

• AMR increased by more than one-third for COVID-19 positive patients (49.2/1000 admissions) who were admitted to the hospital compared to the pre-pandemic period (35.4/1000 admissions, p≤0.001). Notably, the AMR rate during the hospital-onset (HO) setting in the pre-pandemic period was detected in 7.7/1000 patient admissions – while the HO AMR rate increased to 8.6/1000 during the pandemic (p<0.001)².
• The rate of ESBL-producing Enterobacterales cases were significantly higher during the pandemic compared to the pre-pandemic period (2.45 vs. 2.15, p<0.001) ². As we have previously shared (ABR Blog post), this is particularly concerning since ESBL is a multidrug resistant bacterium, often spreads rapidly and is known to complicate infections in healthy patients³.
• Lastly, the percentage of admissions prescribed antibacterial therapy was notably higher during the pandemic versus the pre-pandemic period (36.7% vs 35.0%; P<.001) and significantly higher in COVID-positive patients (57.8%)². We have previously shown that inadequate antimicrobial treatment is more common among COVID-19 positive patients⁴. This can create downstream problems across our healthcare system – including worse outcomes, prolonged hospital stays and, in some cases, in-hospital deaths.

This data adds to a growing body of evidence highlighting the need to invest in diagnostic and antimicrobial stewardship programs aimed at identifying and treating resistance in a timely manner. At BD, we commit to helping slow the spread of antibiotic resistance by improving awareness, surveillance, infection prevention and stewardship.

References:

1. CDC. COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022. https://www.cdc.gov/drugresistance/covid19.html
2. Bauer KA, Puzniak L, Yu K, Klinker KP, Watts J, Moise P, Finelli L, ChinEn A, Gupta V.  A multicenter comparison of prevalence and predictors of antimicrobial resistance in hospitalized patients before and during the SARS-CoV-2 pandemic. Open Forum Infectious Diseases 2022, ofac537, https://doi.org/10.1093/ofid/ofac537
3. Aronin SI, Dunne MW, Yu KC, Watts JA, Gupta V. Increased Rates of Extended-spectrum Beta-lactamase Isolates in Patients Hospitalized with Culture-positive Urinary Enterobacterales in the United States: 2011 – 2020. Diagnostic Microbiology and Infectious Disease, 2022;103(4):115717.  https://doi.org/10.1016/j.diagmicrobio.2022.115717 
4. Puzniak L, Bauer KA, Yu K, Moise P, Finelli L, Ye G, De Anda C, Vankeepuram L, Gupta V.  Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-positive and -negative US Patients with a Positive Bacterial Culture: a Multicenter Evaluation from March to November 2020.  Open Forum Infectious Diseases, Volume 8, Issue 6, June 2021, ofab232, https://doi.org/10.1093/ofid/ofab232

About BD Infectious Disease Insights
Emerging infectious diseases have been increasing in frequency during the past few decades. None have tested the U.S. health care system’s capacity or resiliency like COVID-19 – forever changing the way that we think about future outbreaks and how we manage the related unintended consequences. The BD Infectious Disease Insights series investigates today’s most prominent infectious disease trends. The series leverages the depth and breadth of our data to serve as an ongoing bellwether on the state of infectious diseases in the U.S., backed by clinical insights on how to increase overall awareness and preparedness.

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