Super bug threat potential rising with COVID-19

Bara Vaida

About Bara Vaida

Bara Vaida (@barav) is AHCJ's core topic leader on infectious diseases. An independent journalist, she has written extensively about health policy and infectious diseases. Her work has appeared in outlets that include the National Journal, Agence France-Presse, Bloomberg News, McClatchy News Service, MSNBC, NPR, Politico and The Washington Post.

Photo: Naoki Takano via Flickr

If you are looking for an undercovered story during this pandemic, take a look at the continued threat of antibiotic-resistant pathogens.

There isn’t a lot of data out there, but scientists are watching for signs that COVID-19 patients are being overtreated with antibiotics, which could lead to a surge in super bugs – the term for bacteria and fungus that are resistant to most, if not all, antibiotics.

On Oct. 23, National Geographic reported that infectious disease specialists in hospitals are deeply concerned about a rise in antibiotic-resistant Candida auris, a type of fungus that can cling to sheets, bed railings, doors and medical devices. Hospitalized patients with COVID-19 requiring tubes in their bodies – such as catheters or ventilators – are at the highest risk of contracting resistant C. auris.

“Unfortunately, there have been places where we’ve seen a resurgence of C. auris,”  Tom Chiller, head of the mycotic diseases branch at the U.S. Centers for Disease Control and Prevention told National Geographic. “We’ve also seen it get into some of the acute care hospitals and also into some COVID-19 units … the concern there is that once it sets up shop in a place, it’s hard to get rid of.”

In 2019, the CDC classified C. auris as one of the biggest drug-resistant threats as it has been tied to deaths in 30% to 60% of cases. Each year, about 2.8 million Americans become infected with an antibiotic resistant pathogen and 35,000 die, the CDC said.

Antimicrobial resistance is a natural phenomenon. When a patient sick with a bacteria or fungus is given an antibiotic, the drug kills most of the pathogens – enough for a patient to develop an immune response to get better. But a few pathogens may survive, and those ‘superbugs’ then multiply and spread in the environment. Until about two decades ago, drug companies repeatedly came up with new antibiotics to eliminate the pathogens that had become resistant to a particular drug.

But recent drug industry economics – which reward companies with big profits for drugs that treat chronic diseases – resulted in few investing in new antibiotics. The pipeline for new drugs is so deficient (there are just 41) that many health care providers worry we are already living in a world where an increasing number of people are at risk of infection from a resistant bug that cannot be treated with any antibiotic.

Some early data show that about 70% of COVID-19 hospitalized patients were given antibiotics, though less than 10% had a bacterial infection that required an antibiotic.

“The COVID-19 pandemic will result in increased antimicrobial resistance,” predicted Cornelius (Neil) J. Clancy, M.D., associate chief at the VA Pittsburgh Health System, who researches antimicrobial resistance.

To be sure, there isn’t clear evidence, as of yet, that there has been an acceleration in the spread of antimicrobial resistance, according to the CDC, Axios reported in September.

“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, associate director of the CDC’s healthcare associated infection prevention programs, told Axios.

Meanwhile, in early October, the Trump administration quietly published an update to the National Action Plan for Antibiotic-Resistance, which set federal goals for reducing the incidence of antimicrobial resistant infections. While the plan made recommendations for increased funding in some areas, it lacked specific targets and specific policy recommendations for boosting investment in new antibiotics and reducing resistant infections.

The plan also noted that because of COVID-19, resources at health systems that had been devoted to fighting antibiotic resistance have shifted to focusing on fighting COVID-19.

A few story ideas for reporters to consider:

  • How is your hospital system handling antibiotic stewardship during this moment?
  • With winter coming, a story on how people can tell the difference between a cold, or a bacterial infection. Traditionally, winter has been the season of overprescribing of antibiotics as patients demand them for treating colds, which can’t be treated with antibiotics. How will physicians respond this year?
  • Write about the business angle. Check out CARB-X, a joint public/private vehicle for investment in new antibiotic. What new drugs are close to making it to market?
  • Write about the potential policy debate in Congress that would create a financial incentive for drug companies to invest in antibiotics.
  • Look for stories of individuals who have developed superbugs.

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