Antibiotics misuse and overprescribing revisited ahead of expected fall COVID wave

Almost 80% of patients hospitalized with COVID-19 from March 2020 to October 2020 received an antibiotic, even though less than 3% had any bacterial infection, finds a Centers for Disease Control and Prevention’s (CDC) special report, as quoted by Bloomberg Law.

The CDC’s COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022 points out that “the threat of antimicrobial resistance is not only still present but has become an even more prominent threat” due to new types of resistance developing as bacteria spreads.

David Hyun, director of the Antibiotic Resistance Project at Pew Charitable Trusts, noted that “we’re starting to see increasing numbers of antibiotic-resistant bacteria causing infections in otherwise healthy people in the community,” warning the situation is likely to get worse.

“The annual number of deaths due to highly resistant infections will reach 10 million globally by 2050,” he said.

CDC increases funding for antibiotic stewardship programs

Following the increased rates of deadly bacterial and fungal infections during the COVID-19 pandemic, CDC increased funding for programs to stop improper antibiotic prescribing. As Bloomberg Law noted, it has “already issued $120 million” to departments in over 60 jurisdictions “to expand programs to improve antibiotic and antifungal prescribing within health-care settings.”

The CDC will grant additional funding through 2024.

Many hospitals were successfully implementing such programs in line with the CDC’s Core Elements of Antibiotic Stewardship before the pandemic. However, Hyun said that “a lot of hospitals and health systems struggle to sustain or maintain their existing quality and safety programs” since hospital resources were diverted to the COVID-19 response.

“Historic gains made on antibiotic stewardship were reversed as antibiotics were often the first option given to treat those who presented with a febrile pulmonary process even though this presentation often represented the viral illness of COVID-19, where antibiotics are not effective,” the report underlined.

Antifungal-resistant infections rise, too

Tom Chiller, chief of the CDC’s Mycotic Disease Branch, which aims to prevent illness and death from fungal diseases, says that when patients are prescribed antibiotics for bacterial infections, “the fungi then have sort of a niche because there’s no competition.”

The CDC report shows that antibiotic overuse also exposed patients to an increased risk of antifungal-resistant infections. From 2019 to 2020, hospital-acquired Candida auris infections, a highly antifungal-resistant strain, increased by 60%.

Why we need improved antibiotic stewardship

“If you take an antibiotic when it’s not needed, not only do you increase your own risk of a subsequent infection, but you also open yourself up to potential side effects and adverse events,” said Lauri Hicks, who leads antibiotic stewardship at the CDC.

Pointing out to CDC’s estimates that 80% to 90% of antibiotic prescribing in the US occurs in outpatient settings, antibiotic stewardship leaders say that “improving tracking of antibiotic prescribing in outpatient settings and long-term care facilities will be essential in fighting resistant infections in the coming years.”


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