Before the COVID-19 pandemic, experts had warned of an antibiotic resistance crisis due to an overuse of antibiotics in treating infections and in agriculture.
The pandemic has worsened the crisis, causing a rise in antibiotic-resistant “superbug” infections and deaths in hospitals, according to a report by the Centers for Disease Control and Prevention (CDC).
In 2020, infections and deaths from antimicrobial-resistant bacteria both increased at least 15% in comparison to 2019. One particular type of bacteria called Carbapenem-resistant Acinetobacter—which can cause infections of the blood, urinary tract, lungs, and wounds—drastically increased by 78% in one year.
David Hyun, MD, director of the Antibiotic Resistance Project at the Pew Charitable Trusts, said that when bacteria, viruses, and fungi are resistant to antibiotics, it’s much harder to treat infections.
“Antibiotic resistance happens when bacteria are exposed to different antibiotics and that exposure provides an opportunity for the bacteria to learn and essentially evolve itself to become resistant for its survival,” Hyun said. “That’s how bacteria resistance can jump from one type of bacteria to the other. It’s a very serious situation.”
If the bacteria become resistant to the antibiotic, they can spread from person to person and become more prevalent in the community.
For example, gonorrhea—a sexually transmitted infection—has become increasingly resistant throughout the last couple of decades. From 2017 to 2019, there was an increase in gonorrhea infections with resistance to any of the six antibiotics currently recommended to treat it, according to the CDC.
“We’re down to essentially one antibiotic that can reliably treat gonorrhea infections,” Hyun said. If it’s left undetected or untreated, the disease can cause serious health complications and continue to circulate in a community, increasing the chances of it developing resistance to available treatments and potentially others.
Early in the pandemic, many hospitalized COVID-19 patients were prescribed antibiotics because little was known about the ideal treatment of the virus, Hyun said. From March to October 2020, nearly 80% of patients hospitalized with COVID-19 received an antibiotic, even though studies have found only a small portion of those patients had bacterial confections.
“The more antibiotics are used, the more likely there will be a higher risk for the emergence and development of antibiotic resistance,” Hyun said. “The stronger antibiotics are used in the hospital, the more likely that there’s going to be resistant bacteria emerging from those environments as well.”
In addition, hospitalized COVID-19 patients had much longer stays compared to a typical patient that was admitted to the hospital for something else. COVID-19 patients also had more frequent and longer use of medical equipment or invasive therapies, such as catheters and ventilators, which can increase the risk of infections and the spread of pathogens, Hyun said.
When combined with staff, supply, and personal protective equipment shortages, the risk of infection increases as well.
But the increased habit of handwashing and disinfecting likely did not contribute to antimicrobial resistance, Hyun noted. “Hand sanitizer, Clorox wipes and others are not antibiotics per se because those things are a different mechanism,” he said.
Even before the pandemic, there has been a long-term problem of overprescribing antibiotics in situations where they may not have been needed, according to Neera Ahuja, MD, a clinical professor of medicine at Stanford Hospital and Clinics.
Furthermore, the increase in telemedicine has limited the physical examination of patients, potentially prompting a “play it safe” approach where a provider will prescribe an antibiotic for what may be a viral illness, Ahuja explained.
According to the CDC’s report, more than 29,400 people died of antimicrobial-resistant infections in healthcare settings in 2020. Nearly 40% got infected while hospitalized and the remaining infections took place in nursing homes and other community healthcare settings.
Hyun said people who are immunocompromised are at the highest risk for developing antibiotic-resistant infections and having worse health outcomes. Newborns are also at risk because they don’t have fully developed immune systems. Those who have chronic illnesses and can’t fight off or prevent infections may be at risk too.
While completely healthy people are not considered to be the most at-risk of getting antibiotic-resistant infections, Hyun added, they aren’t completely out of the picture because those infections are “starting to creep into the communities,” beyond the healthcare settings.
One way to combat antibacterial resistance is through education both to the public and medical professionals.
It’s important to continue and develop antimicrobial stewardship programs in hospitals, which help medical professionals choose the best antibiotic for a patient to treat any bacterial infection and reduce unnecessary use of the drugs, Javeed Siddiqui, MD, MPH, cofounder and Chief Medical Officer of TeleMed2U, told Verywell in an email.
Siddiqui said these programs should also be established in community healthcare settings, including doctor’s offices, urgent care centers, nursing homes, and specialized outpatient services like dentistry or pain management clinics.
In addition to scaling back antibiotic usage, Hyun suggested that more resources and research are needed to create new antibiotics.
Lastly, everyone has an important role when it comes to antibiotic use. Patients who see a doctor when they’re sick must keep an open mind and have a good understanding of how antibiotics are used and when they are needed or not.
“We strongly encourage patients when they’re seeing doctors to have an open conversation about the risk and benefits of antibiotics and ask questions about their condition and whether they truly need one,” Hyun said. “That’s probably one of the most important roles patients can play in terms of reducing inappropriate antibiotic use.”
If you are sick or have an infection, you may not necessarily need an antibiotic for treatment. Have a conversation with your healthcare provider about the risk and benefits of using an antibiotic in your situation to determine if one is truly needed.