Drug-resistant infections have …

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Atlanta – The frequent misuse of antibiotics and a lack of control measures fueled the spread of resistant pathogens in the United States in the first year of the pandemic. According to a report by the Centers for Disease Control and Prevention (CDC), nosocomial infections and deaths from resistant pathogens increased by at least 15% in 2020.

In the early days of the pandemic, according to the report, with no effective drugs against COVID-19 and no means of protecting personnel through vaccination, important progress was lost in the fight against the spread of resistant pathogens.

From March to October, 80% of patients hospitalized for COVID-19 received antibiotics, although these cannot do anything against SARS-CoV-2 – except in the case of bacterial superinfection. Due to the chaotic situation in many clinics, the measures introduced in recent years for the economical and purposeful use of antibiotics have also been ignored, the authorities complain.

The result was an increase in infections with resistant pathogens. According to the report, relapse was most pronounced in carbapenem-resistant Acinetobacter. These pathogens occur mainly in patients in intensive care units.

As the occupancy rate during the pandemic increased and the duration of treatment increased, resistant pathogens may have spread. After a steady decline between 2012 and 2017, the number of cases increased by 78% in 2020. The CDC lists 7,500 cases.

Candida auris infections, which do not respond to fungistatics, have also increased significantly. These infections were first recorded in 2015. They are found primarily in acute care facilities such as long-term care. This number has grown steadily in recent years. In 2020, there was another increase of 60% to 754 infections. In 2020, they also included outbreaks in acute care hospitals, especially in COVID-19 units.

There has also been an increase in infections with resistant fungi in other Candida species. CDC reports a 26 percent increase to 28,100 infections in 2020 after several years of decline. Possible causes include overcrowding in hospitals, increased numbers of sick patients and a shortage of staff, which the report said could have had a negative impact on infection control and the use of antifungal medications.

An increase of 35% to 12,700 cases in 2020 is the number of nosocomial infections with carbapenem-resistant enterobacteria (CRE), some of which are resistant to almost all antibiotics. These infections are most common in patients who require catheters, which are an important port of entry. The number of CRE cases decreased significantly from 2017 to 2018, with an increase in 2019 which continued in 2020.

There was an increase of 32% in hospitals and 7% in outpatients for ESBL-producing Enterobacterale. In 2020, a total of 197,500 cases were reported to the CDC. One of the reasons may be the increase in the number of sick patients treated in hospital for a long time. Infections with these bacteria can often only be cured by intravenous administration of carbapenems.

Patients infected with vancomycin-resistant enterococci (VRE) often have a weak immune system and require complex or long-term treatment. The 16% increase compared to 2019 may be due to staff shortages and inconsistent application of precautionary measures. CDC recorded 50,300 infections.

Multiple drug resistant infections (MDRs) of Pseudomonas aeruginosa increased by 32%, some of which no longer respond to carbapenems. Patients with chronic lung disease whose immune system is weakened are often affected. The favorable trend of recent years has also reversed here, which has led to a steady decline. CDC recorded 28,800 infections.

Resistance in Neisseria gonorrhoeae has become an issue in recent years. Oral penicillin treatment, which was simple in the past, has long since been no longer possible. Some patients now need to be treated parenterally with ceftriaxone.

There was an increase of 46% in 2017-2018 and 17% in 2018-2019 to 942,000 resistant gonococcal infections. There are no figures for 2020 yet. Time will tell if the blockage and other measures led to a decline here.

The situation regarding Clostridioides difficile intestinal infections (CDI), which is the result of the frequent use of broad-spectrum antibiotics, is also unclear. More accurate diagnosis and targeted use (“antibiotic management”) programs have led to a decline in CDI in recent years. It is not yet clear whether this trend will continue in 2020 as data is not yet available. In 2019, there were still 202,600 CDI cases.

There are also no data available on infection for resistant Streptococcus pneumoniae. According to the report, preliminary data points to a decline compared to the last 5 years. According to the CDC, this may be due to the introduction of a new vaccine that covers more serotypes and thus offers wider protection against vaccination.

Erythromycin-resistant group A streptococci (GAS) may also have decreased in 2020. GAS is the most common bacterial pathogen of respiratory infections, whose numbers have declined due to measures taken against SARS-CoV-2.

How clindamycin-resistant group B streptococci (GBS) evolved, which causes serious disease in people of all ages – including bloodstream infections, pneumonia, meningitis, and skin infections – is also not known yet.

Campylobacter and non-neurodermal intestinal infections decreased by 23% and 22%, respectively, in the first year of the pandemic. These infections are often acquired over long journeys, which was no longer possible in the first year of the pandemic.

According to the CDC, avoiding meals in restaurants may have contributed as well. But it may also be that fear of COVID-19 has kept many people from seeing a doctor for abdominal symptoms. Telemedicine advice may have resulted in fewer stool sample tests. On the positive side, the percentage of Campylobacter with reduced antibiotic sensitivity has also decreased.

Infections with the Salmonella Typhi serotype, which are usually acquired over long journeys, fell by more than half in the first year of the pandemic. However, the percentage of resistant germs has risen to 85%. Shigella infections have also become less frequent. Here too, the percentage of resistant germs has increased, especially among men who have sex with men (MSM).

The number of drug-resistant tuberculosis infections fell by 22% to 6,513. This may be due to the increase in the number of undiagnosed diseases. On the other hand, the number of migrants who belong to the most important risk groups has decreased. The total number of tuberculosis cases also fell by 19%. © rme / aerzteblatt.de

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