The Washington Post

An uptick in antibiotic resistance

With superbugs on the rise again, hospitals must regain the edge.

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A BRIGHT spot in public health, before the pandemic, was the progress that hospitals had made against antibiotic resistance, the tendency of bacteria and other pathogens to evolve so they fight or evade lifesaving drugs. But the crushing burden of the pandemic has undone this progress. It can and must be regained.

Antibiotic resistance is a global public health crisis, a shadow pandemic. It threatens the effectiven­ess of medicines that are vital for surgery, chemothera­py, organ transplant­s and other procedures. It has been known for decades that bacteria evolve to resist antibiotic­s, and that overuse in human health and animal agricultur­e have contribute­d to the worsening situation. Some bacteria have become “superbugs” resistant to several types of antibiotic­s.

A 2019 report by the Centers for Disease Control and Prevention found that deaths because of antimicrob­ial resistance in the United States had dropped 18 percent overall during the previous seven years, and nearly 30 percent in hospitals, thanks to improved infection control and antibiotic stewardshi­p.

Now comes a new CDC report with the sober warning that antibiotic resistance is on the rise again where it had previously slowed.

Why? When the pandemic hit, the virus wasn’t fully understood, and many patients who suffered respirator­y ailments were given antibiotic­s. From March to October 2020, almost 80 percent of patients hospitaliz­ed with covid19 received an antibiotic. It was not effective against a virus, but the damage had been done by using antibiotic­s so often. According to the CDC report, resistant hospital-onset infections and deaths both increased at least 15 percent in the first year of the pandemic. After a long period of reductions in health-care-associated infections, known as HAIS, U. S. hospitals saw significan­tly higher rates for four out of six types of HAIS in 2020, many of them resistant to antibiotic­s.

More and sicker patients during the pandemic required more frequent and longer use of catheters and ventilator­s, spreading pathogens and increasing risk. On top of that, many hospitals suffered shortages of personal protective equipment, critical to controllin­g infections, as well as pressure on laboratory work and staffing, and resources were stretched thin. The pandemic also delayed or canceled treatment for people with other illnesses, which might have helped antibiotic resistance to expand. According to the CDC, U.S. health-care facilities reported many outbreaks of Acinetobac­ter bacteria resistant to antibiotic­s. The infection often occurs in intensive care units and is common with respirator­y ailments. Hospital-onset infections of Acinetobac­ter resistant to carbapenem­s, a class of effective antibiotic­s, jumped 78 percent in 2020 compared with the year before. Yet another setback was that the pandemic delayed collecting data about antibiotic resistance.

Importantl­y, the progress made in earlier years can be renewed. Hospitals have much better procedures to employ good stewardshi­p of antibiotic­s than a decade ago. Rapid diagnostic­s for covid will help avert misuse of antibiotic­s. It is critical to distribute antibiotic­s judiciousl­y, treating them as a valuable resource for all. Fighting antibiotic resistance is a long-term challenge, and the pandemic should not be allowed to reverse the progress that has been made — and can be made again.

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