CDC: Pandemic Spurred Deadly Antimicrobial-Resistant Infections

A new CDC report warned that progress against deadly antimicrobial-resistant infections reversed course during the first year of the COVID-19 pandemic.

After years of steady declines, antimicrobial-resistant hospital-related deaths and infections from seven pathogens grew 15% from 2019 to 2020, including increases of:

• 78% for carbapenem-resistant Acinetobacter infections
• 35% for carbapenem-resistant Enterobacterales infections
• 32% for multidrug-resistant Pseudomonas aeruginosa infections
• 32% for extended spectrum beta-lactamase (ESBL)-producing Enterobacterales infections
• 14% for vancomycin-resistant Enterococcus (VRE) infections
• 13% for methicillin-resistant Staphylococcus aureus (MRSA) infections
• 10% for drug-resistant Salmonella serotype Typhi infections

According to CDC's "COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022," over 29,400 people in the U.S. died in 2020 from antimicrobial-resistant infections commonly linked to healthcare, with nearly 40% acquired during hospital stays.

But the true toll may be far higher, with the report citing data gaps caused by the COVID-19 pandemic -- data were either unavailable or delayed for half of the 18 pathogens listed in CDC's 2019 Antibiotic Resistance Threats report. That report estimated that 2.8 million of these difficult-to-treat infections occur each year in the U.S., resulting in 35,000 deaths.

"This setback can and must be temporary," Michael Craig, MPP, director of CDC's Antibiotic Resistance Coordination & Strategy Unit, said in a statement from the agency.

"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," said Craig. "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."

Six of the infections that increased in 2020 -- VRE, MRSA, ESBL-producing Enterobacterales, multidrug-resistant P. aeruginosa, and carbapenem-resistant Acinetobacter and Enterobacterales -- rack up $4.6 billion in healthcare-related costs in the U.S. each year, according to a recent analysis.

The new report also highlighted the pandemic's effect on antifungal-resistant infections, on antibiotic prescribing, and on the U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB). But it wasn't all bad news, as the report credits hospital programs targeting antimicrobial resistance with helping reduce the spread of COVID-19.

Antifungal-Resistant Infections

From 2019 to 2020, antifungal-resistant infections surged as well, including a 60% overall increase in Candida auris infections and a 26% rise in hospital-related Candida species (excluding C. auris). Clostridioides difficile decreased, though the report suggested this was most likely due to changes in healthcare-seeking behavior.

Antibiotic Prescribing

Hospitals struggled to follow protocols and guidance for reducing antibiotic prescribing during the pandemic, according to the report. From March through October 2020, for example, nearly 80% of hospitalized COVID patients were treated with an antibiotic. Long hospital stays and the intensive care often associated with COVID-19 likely contributed to this trend as well.

"While some of this prescribing can be appropriate when risks for related bacterial or fungal infections are unknown, this antibiotic prescribing can also put patients at risk for side effects and further the pressure for resistance to develop and spread," according to the report.

Effect on National Action Plan

To combat antimicrobial resistance, the CDC called for further investment in the nation's healthcare infrastructure, and highlighted the following key areas:

• Tracking and data
• Preventing infections
• Antibiotic/antifungal use
• Environment and sanitation
• Vaccines, therapeutics, and diagnostics

"We need to emphasize and expand the implementation of the effective prevention strategies that are already in CDC's toolbox to all healthcare facilities," said CDC's Denise Cardo, MD, director of the agency's Division of Healthcare Quality Promotion.

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