The problem of superbugs was brewing before the pandemic and has only worsened in the past two years in some parts of the country. In 2019, the CDC said about 35,000 people a year in the U.S. die from a drug-resistant infection, up from 2013 when the agency estimated about 21,000 were dying annually from a superbug. (This is the latest national data available from the CDC.)
“We’ve seen a rise in broad-spectrum antibacterial use nationwide during this pandemic,” said Shruti Gohil, M.D., M.P.H., associate medical director of epidemiology and infection prevention at the University of California, Irvine School of Medicine. And “there has also been a rise in multidrug-resistant organism infections, specifically” in hospitals.
If you’re looking for important health stories that will endure post-COVID-19, get up to speed on covering antibiotic resistance. Let’s start with some background information and explore the latest data.
A deep dive into antibiotic resistance
Antibiotic 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. Older patients and those with compromised immune systems are among the most vulnerable to these resistant bacteria.
In the fourth quarter of 2020, hospitals reported a 41% increase in infection events caused by bacteriemia, a type of bloodstream, and often drug-resistant pathogen, according to the CDC. The rise in infection event was likely related to the large increase in COVID-19 patients admitted to hospitals that needed ventilators and catheters and other equipment to keep them alive, but also create opportunities for bacteria to enter the body.
Antibiotic overuse and the pandemic
In the overwhelming rush to save patients, especially in the early days of the pandemic, health care providers also likely administered too many antibiotics, because there wasn’t much else to treat them with. One 2020 study showed that 70% of hospitalized patients was administered an antibiotic when less than 10% had a bacterial infection that required it.
For the past decade, the U.S. has been making progress in reducing hospital-related infections and inappropriate antibiotic use through stewardship programs, but the pandemic erased some of that success, as infection control staff and resources were diverting toward responding to patients with COVID-19, said Gohil.
“It’s not surprising” to see increasing antibiotic resistance, she said. “It’s a reminder that [antibiotic] stewardship and mechanisms that we had in place [prior to the pandemic] worked…and when we had to put them on pause.. you see the consequences… of rising infections.”
Five tips for covering antibiotic resistance
- Remind readers of life before antibiotics. COVID-19 illustrates humans’ vulnerability to pathogens in a way that hasn’t been seen for almost a generation. Before the era of antibiotics (first discovered in 1928, but didn’t reach mass production until the 1940s) deaths from bacterial infections were common. According to the Infectious Disease Society of America, people had an 11% chance of dying from a skin infection, almost the same risk of having a heart attack today. Without antibiotics, most modern medicine couldn’t exist, as the risk of mortality from knee surgery, for example, or cancer treatment might be greater than the ailment itself.
- Antibiotic resistance, like the COVID-19 pandemic, is a shared societal problem. What happens in hospitals can spread to the world. Resistant bacteria in humans can jump to other people. That’s why taking an unnecessary antibiotic doesn’t just impact the person. If someone develops a resistant infection, it can spread to others in the community. “It is [about] the transmissibility of resistance,” says Brad Spellberg, M.D., chief medical officer at Los Angeles County and University of Southern California Medical Center. “When you use an antibiotic, it is going to affect my future grandchildren’s ability to have that antibiotic available for their use. We are all in this together.” See this story: “The social dilemma of antibiotic use.”
- Antimicrobial resistance is brewing in food animal farming, so write about agriculture and antibiotics. The use of antibiotics in animals has evolved since the 1950s when researchers discovered the drugs sped up the growth of animals and prevented infection. The discovery resulted in the expansion of food farming, where farms raise large numbers of animals in close proximity and prevent infection before they are slaughtered (known as concentrated animal feed operation). In 2019, 6.1 kilograms or more than 13 million pounds of antibiotics, like penicillin and tetracycline, were sold to U.S. farmers for cattle, swine, turkeys and chicken, largely for use in animal feed and water. However, the large amounts of antibiotics being used are exposing quintillions of bacteria to antibiotics and teaching them how to become resistant. Consumer and environmental groups have been pushing back at the overuse of antibiotics in food farming by publishing ‘report cards’ on restaurant chains that sell food with antibiotics and that has had an impact in reducing the use of antibiotics in food farming. See health journalist Maryn McKenna’s book ‘Big Chicken’ for background on the animal/human antibiotic resistance story.
- Don’t cast this as a story about how to win the war against microbes. There are billions more of them than humans and they will never stop developing resistance. Antibiotic resistance emerged almost as soon antibiotics were discovered and began to be widely used in the 1940s. “We have to stop viewing our relationship with microbes as a winnable war,” Spellberg said. “It is not winnable. There is no end game.” Spellberg recommends reporters write about their local hospital’s efforts to preserve the effectiveness of existing antimicrobials (drugs that kill microbes like bacteria and fungi) and write about how people can prevent infections through hand washing, vaccines, and judicious use of antibiotics. Remind people that antibiotics only kill bacteria and fungi, not viruses and that they shouldn’t ask their doctors to prescribe antibiotics for treating COVID-19, colds, nasal congestion or the flu. “I would like to see the media start telling the story of [antibiotic] sustainability,” he says.
- Focus your reporting on research for antibiotic alternatives. For almost a decade, the story has been that the world’s drug companies aren’t investing in enough new antibiotics to treat drug-resistant infections. This remains an important story, but because humans will never stop the development of antibiotic resistance, investigate the science on outside-the-box approaches to resistance, such as vaccines and bacteriophage (viruses that kill bacteria) therapies. The Pew Charitable Trusts said that as of March 2021, 36 candidates in clinical development could become alternatives to antibiotics in treating infections if successful. See this National Academy of Medicine article for background.
For experts to call and other story ideas, check out AHCJ’s covering antibiotic resistance tip sheet.