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CDC official: Pandemic "explosion" of antibiotic resistance not seen

Despite concerns over antimicrobial resistance flourishing during the pandemic as doctors use all their tools to help patients fight COVID-19, early indications are that their efforts may not be causing a large increase, a CDC official tells Axios.

Why it matters: AMR is a growing problem, as the misuse or overuse of antibiotics creates resistant pathogens that cause more than 2.8 million infections and 35,000 deaths annually in the U.S.

What's happening: COVID-19 appears to present "the perfect storm" for AMR infections due to the longer length of hospital stays (averaging 8.4 days), crowding, PPE shortages, and intrusive treatments, says Arjun Srinivasan, CDC’s associate director for Healthcare Associated Infection Prevention Programs.

  • "People are prescribing antibiotics because they're concerned the patient may have a bacterial superinfection when [sometimes] it's actually just the signs and symptoms of COVID," Amy Mathers, associate professor at University of Virginia's School of Medicine, tells Axios.
  • "[W]e don't know what the disease pattern is yet and we're erring on the side of caution [with a] sort of overprescription of antibiotics," says Mathers, who is also clinical director of the Adult Antimicrobial Stewardship Program at UV Medical Center.
  • Some recent studies have indicated that the proportion of COVID-19 patients who end up with a bacterial co-infection is low, with some saying the routine use of antibiotics is not recommended.

Threat level: An analysis found 72% of COVID-19 patients received antibiotics that only 8% needed, meaning the “potential for a surge in AMR following this pandemic is real,” Admiral Brett P. Giroir, assistant secretary for health, pointed out at a meeting this week of a presidential advisory council for AMR.

  • But, new early data foundthat while antibiotic use remains up overall — and remains a concern — it has fallen from its uptick in March and April and there's been no huge boost in most AMR infections yet.
"We were all kind of very worried that we would see this explosion in antibiotic resistance. ... So, I think we were pleasantly surprised to see that while there are clearly patients with COVID who developed resistant infections, we didn't see them in the huge numbers that I think many people had feared."
Arjun Srinivasan

The latest: Srinivisan presented some early CDC data to the presidential advisory council. The preliminary antibiotic usage findings, from more than 1,100 hospitals with more than 2 million discharges, include...

  • There's no clear evidence COVID-19 patients are more susceptible to bacteria and fungus infections than patients with influenza-like illnesses (ILI), like the flu and pneumonia. They were comparing ILI patients from January to March 2019 with COVID-19 patients from January to June 2020.
  • The number of COVID-19 patients with positive cultures of highly resistant organisms were not much higher than ILI patients last year, but "sporadic outbreaks" and a higher number of hospital-acquired infections were reported.
  • One exception was finding more ESBLs, a bacteria-produced enzyme that can break down antibiotics, in COVID-19 patients — it was 43% higher than in ILI patients last year. "Whether this represents the growing presence of ESBLs [overall] ... or some unique susceptibility to ESBLs in patients with COVID is unknown," Srinivisan says.
  • But the largest AMR concern amongst all hospitalized patients — MRSA — was 7% lower in COVID-19 patients than in those with ILI last year.

The big picture: Srinivasan says it's "vitally important" to continue focusing on developing a new antibiotic development pipeline because "even if we use them perfectly, they become less effective over time."

What to watch: The FDA will host a meeting next month to present a five-year strategic plan for the National Antimicrobial Resistance Monitoring System (NARMS).

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