US study finds some increase in resistant infections during pandemic
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LISBON, Portugal — An analysis of antimicrobial resistance at more than 270 U.S. hospitals found some increase during the first 20 months of the COVID-19 pandemic compared with the prior 8 months.
The research was conducted by Becton, Dickinson and Company, Merck and Pfizer. It was presented at the European Congress of Clinical Microbiology and Infectious Diseases.
“It is particularly worrying that antibiotic resistance has been rising during the pandemic in both SARS-CoV-2-positive and SARS-CoV-2-negative patients,” Merck’s Karri A. Bauer, PharmD, said in a news release announcing the findings. “Hospital-acquired infections are a major concern, with antimicrobial resistance rates significantly higher during the pandemic than before,”
In 2019, more than 1.2 million people in the U.S. died from an antimicrobial-resistant infection. Bauer and colleagues conducted a multicenter, retrospective cohort analysis of hospitalized adults in 271 American hospitals to further examine antimicrobial-resistant infections.
The study included patients who were hospitalized for at least 1 day and were tested for antimicrobial resistance at admission. The researchers categorized patients into two groups — those hospitalized from July 1, 2019, through Feb. 29, 2020, and those hospitalized during the pandemic from March 1, 2020, through Oct. 30, 2021.
There were nearly 1.8 million hospital admissions in the pre-pandemic period compared with more than 3.7 million during it. The antimicrobial resistance (AMR) rate during the pre-pandemic period was 3.54 per 1,000 admissions compared with 3.47 per 1,000 during the pandemic.
Patients who tested positive for COVID-19 had an AMR rate of 4.92 per 1,000 compared with 4.11 per 1,000 among who tested negative, and 2.57 per 1,000 who did not test at all. The community-onset AMR rate before the pandemic was 2.76 per 1,000 compared with 2.61 during the pandemic.
The rates for hospital-associated AMR infections were 0.77 per 1,000 admissions before the pandemic and 0.86 per 1,000 during the pandemic, with the highest rate recorded among those who tested positive for COVID-19 (2.18 per 1,000).
“These new data highlight the importance of closely monitoring the impact of COVID-19 on antimicrobial resistance rates,” Bauer said.
Perspective
Back to TopCornelius (Neil) J. Clancy, MD
It's interesting. In a lot of ways, it echoes some of the preliminary data that the CDC presented but to my knowledge had not yet published, where they found increased rates of certain AMR hospital-acquired infections.
It looks like they found here — comparing the pandemic and pre-pandemic periods — that hospital-onset AMR was increased, probably driven largely by the people who were tested for COVID-19, with both positive and negative results. That probably speaks to the fact that people you're testing for COVID-19 are sort of at high risk for AMR-type pathogens. For example, nursing home residents, people with underlying heart and lung disease, diabetes.
I suppose from that point of view, you could [ask]: Are the data surprising or not surprising, because there's been debate in the field about whether we would see an uptick in AMR or not with COVID-19.
It looks like with hospital-onset infections and AMR infections, there probably is a bit of an uptick. I think it speaks to the fact that people sick enough to come to the hospital tend to stay in the hospital for a long period of time, and tend to have other risk factors for AMR. There also were strains placed on infection prevention — and during this time period, perhaps maybe staffing shortages as well. I think all of these things have come together.
Regardless of what happens with final numbers, AMR was a big problem, hospital-acquired infections were a big problem. Hospital-acquired AMR was a big problem before the pandemic, and it's still a big problem.
The community numbers of resistant infections may be down a bit, but they still remain a big problem in the community. What you’re seeing is MRSA in that data, you're seeing [extended-spectrum beta lactamase], you're seeing the things that that you're worried about.
I think hospital antibiotic use is back to where it was, or maybe up a little bit and normalized. The community use had dropped, and then it slowly crept back up. I think that's pretty much the survey of where we are right now.
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Bauer KA, et al. Abstract 04960. Presented at: European Congress of Clinical Microbiology and Infectious Diseases; April 23-26, 2022; Lisbon, Portugal (hybrid meeting).
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